Writing Homework Help

Case Studies Angina

The patient was a 48-year-old man admitted to the coronary care unit complaining of substernal chest pain. During the 4 months preceding admission, he noted chest pain radiating to his neck and jaw during exercise or emotional upsets. The pain dissipated when he discontinued the activity or relaxed. The results of his physical examination were essentially normal except for a systolic murmur heard best at the apex of the precordium and radiating into the left axilla.

Studies	Results
Routine laboratory work	Within normal limits (WNL)
Cardiac enzyme studies
Creatine phosphokinase (CPK), p. 167	235 units/L (normal: 55–170 units/L)
CPK-MB, p. 171	12 ng/mL (normal: 0–3 ng/mL)
Lactic dehydrogenase (LDH), p. 293	120 units/L (normal: 90–200 units/L)
Serum aspartate aminotransferase (AST), p. 107	24 International units/L (normal: 5–40 International units/L)
Troponins, p. 451	18 ng/mL
Echocardiography, p. 820	Hypokinetic portion of the lateral left ventricle
Electrocardiography (EKG), p. 485	Evidence of left ventricular hypertrophy
Chest x-ray study, p. 956	WNL
Exercise stress test, p. 481	Positive: pain reproduced; ST segment depression noted on EKG (normal: negative)
Echocardiography, p. 820	Normal ventricular wall motion
Transesophageal echocardiography (TEE), p. 840	Mitral regurgitation, dilated left atrium
Lipoproteins, p. 304
HDL	29 mg/dL (normal: >45 mg/dL)
LDL	189 mg/dL (normal: 60–180 mg/dL)
VLDL	12 mg/dL (normal: 7–32 mg/dL)
Homocysteine, p. 269	16 mol/L
C-reactive protein (CRP), p. 165	22 mg/dL
Cardiac catheterization, p. 950	All WNL except:
Pressures
Left ventricular systolic pressure	140 mm Hg (normal: 90–140 mm Hg)
Aortic systolic pressure	130 mm Hg (normal: 90–140 mm Hg)
Ventricular-aortic pressure gradient	5 mm Hg (normal: 0)
Left ventricular function
Cardiac output	3.5 L/min (normal: 3–6 L/min)
End diastolic volume (EDV)	60 mL/m2 (normal: 50–90 mL/m2)
End systolic volume (ESV)	22 mL/m2 (normal: 25 mL/m2)
Stroke volume (SV)	38 mL/m2 (SV = EDV − ESV)
Ejection fraction	0.63 (normal: 0.67 ± 0.07)
Cineventriculography	Mitral regurgitation present, normal muscle function (normal: normal ventricle)
Analysis of O2 gas content, p. 98	No shunting (normal: no shunting)
Coronary angiography (coronary cineangiography), p. 950	90% narrowing of left coronary artery (normal: no narrowing)
Cardiac radio-nuclear scanning, p. 733	Scans normal showed localized area of decreased perfusion and poor muscle function in the myocardium during exercise
Cholesterol, p. 138	502 mg/dL (normal: <200 mg/dL)
Triglycerides, p. 447	198 mg/dL (normal: 40–150 mg/dL)

Diagnostic Analysis

Cardiac radio-nuclear scanning, EKG, and studies ruled out the possibility of MI. Troponins and serial cardiac enzyme indicated cardiac ischemia. Stress testing and a nucleotide scan indicated that the patient was having exercise-related myocardial ischemia (angina). Echocardiography indicated that the heart muscle at the site of ischemia was functioning poorly. Transesophageal echocardiography indicated that the patient had mitral regurgitation. Cardiac catheterization with cineventriculography demonstrated near-normal ventricular function, and coronary angiography indicated significant narrowing of the left coronary artery. Mitral regurgitation was also seen. The patient’s angina was then thought to be caused by the coronary artery disease. Open heart surgery was performed. The patient’s mitral valve was replaced with a prosthesis, and an aortocoronary artery bypass graft was performed. Postoperatively, he had a large pericardial effusion. This diminished his heart function. He underwent pericardiocentesis, and his function improved. Because his serum lipids study showed type IIa hyperlipidemia, a low-cholesterol diet and cholesterol-lowering agents were prescribed. The other cardiac risk factors did indicate increased risk for coronary heart disease. Six months later he was asymptomatic and jogging 3 miles per day.

Questions:

1. Based on the ratio of cholesterol to HDL, what is the patient’s risk for coronary heart disease?

2. If these blood tests were drawn 1 year ago, what treatment would have been indicated?

3. Could surgery have been avoided?

Case Studies Alzheimer’s

Instructions: Read the following case study and answer the reflective questions. Please provide
rationales for your answers. Make sure to provide a citation for your answers.

CASE STUDY: Family Member with Alzheimer’s Disease: Mark and Jacqueline
Mark and Jacqueline have been married for 30 years. They have grown children who live in another
state. Jacqueline’s mother has moved in with the couple because she has Alzheimer’s disease.
Jacqueline is an only child and always promised her mother that she would care for her in her old
age. Her mother is unaware of her surroundings and often calls out for her daughter Jackie when
Jacqueline is in the room. Jacqueline reassures her mother that she is there to help, but to no avail.
Jacqueline is unable to visit her children on holidays because she must attend to her mother’s daily
needs. She is reluctant to visit friends or even go out to a movie because of her mother’s care needs
or because she is too tired. Even though she has eliminated most leisure activities with Mark,
Jacqueline goes to bed at night with many of her caregiving tasks unfinished. She tries to visit with
her mother during the day, but her mother rejects any contact with her daughter. Planning for the
upcoming holidays seems impossible to Mark, because of his wife’s inability to focus on anything
except her mother’s care.
Jacqueline has difficulty sleeping at night and is unable to discuss plans even a few days in
advance. She is unable to visit friends and is reluctant to have friends visit because of the
unpredictable behavior of her mother and her need to attend to the daily care.

Reflective Questions

1. How do you think this situation reflects Jacqueline’s sense of role performance?

2. How do you think that Jacqueline may be contributing to her own health?