1 / 16

Case Study

Case Study. On patient with left arm numbness and tingling…. By: Shaina Joseph. Chief Complaint:. “I felt tingling and numbness in my left arm.”. HPI

seamus
Download Presentation

Case Study

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Study On patient with left arm numbness and tingling… By: Shaina Joseph

  2. Chief Complaint: “I felt tingling and numbness in my left arm.” • HPI • This patient is a 51 year old, African American female that came to the hospital upon feeling tingling and numbness in her left arm. She came out of the storeroom at work and noticed it around 3:15pm yesterday. She felt tingling and numbness on her left arm and her legs felt heavy. She described the numbness feeling as if it would “when you fall asleep on your arm or when your foot falls asleep”. She took an aspirin and headed straight to the hospital in fear that it could signify something serious like a heart attack.

  3. PMH: -N/APSH: -Tubal LigationFMH:-My patient’s father died of TB, and her mother died of an aneurism. Her mother passed away when she was only 4 years old, and her father passed away when she was 9 years old. She knows what they passed away from but was not aware if they suffered from any other problems. Her siblings do not have any issues, nor do her children.Allergies:-NKA

  4. Findings Subjective: -AOx3 -No Allergies -pain was a 0/10 Objective: -Blood Pressure= 106/64 -Oral Temperature= 98.1 -Pulse=50 -Respirations=20 -02 Sat= 99 -Room Air

  5. Labs: • WBC:7.3[normal-5,000-10,000] • RBC:4.39 [normal= 4.2-5.4 million] • Hgb: 13.9 [normal-12-16] • Hct:41[normal=38-47%] • Sodium:138[normal-135-145] • Potassium:4.2[normal=3.5-5] • Glucose:98[normal-70-110] • BUN:16[normal= 6-20] • Calcium 9.2[normal-8.9-10.3] • LDL:*127[normal=LDL<100] • HDL:*44[normal-HDL 60+ is high, <50 is low] • Cholesterol:198[normal- <200 is desirable]

  6. Testing: • MRI- 2/11/13- test was clear. • EEG-2/12/13- also was clear. • According to the report, there was normal left ventricular wall thickness. Left ventricular systolic function was normal. There were no regional wall motion abnormalities noted, and the left atrial size, the mitral valve, and the aortic valve were normal.

  7. Pathophysiology Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart is starved of oxygen and heart cells die. This is known as myocardial infarction. Now, a heart attack can result from a blood clot blocking blood flow or result from a buildup of hardened plaque, a substance made up of cholesterol, fat, and other substances, in your coronary arteries. If the plaque breaks open, the clotting process (thrombosis) begins in the artery. As thrombosis progresses, blood supply to the heart reduces and causes the heart muscle to die. This reduction in blood supply brings about the symptoms of a heart attack (NIH,2011).

  8. Patho continued… • The most common symptom is chest pain, during which people feel tightness in their chest for a good, few minutes. Not everyone feels chest pain though. The following symptoms may/ may not be experienced as well: shortness of breath, sweating, fainting, anxiety, cough, weakness, light-headedness, palpitations (Mayo Clinic, 2011). Because heart muscle is dying, these symptoms will start to show and indicate you are having a heart attack. Unless, you are to have a “silent heart attack”, during which you have no symptoms. • Treatment involves being hooked up to a heart monitor, receiving oxygen, an IV placed in your veins to deliver meds and fluids, nitroglycerin (if there’s chest pain), and aspirin (NIH, 2011). • Before deciding on treatment, an EKG or a Troponin Blood Test can tell you if there’s been heart damage, confirming a heart attack. A coronary angiography can also be done, and this test uses a special dye to see how the blood flows through the heart (NIH, 2011). Mayo Clinic. "Heart Attack Symptoms: Know What's a Medical Emergency." Mayo Clinic. Mayo Foundation for Medical Education and Research, 22 July 2011. Web. 15 Feb. 2013."What Are the Signs and Symptoms of a Heart Attack?" National Institutes of Health: National Heart, Lung, and Blood Institute. N.p., 1 Mar. 2011. Web. 14 Feb. 2013.

  9. Medications: Rosuvastatin (Crestor): 2.5 mg (.5 tab) PO at bedtime -indication: management of hypercholesterolemia and hypertriglyceridemia; slows progression of atherosclerosis; prevents cardiovascular disease. Aspirin: I cap PO BID -indication: inflammatory disorders; mild to moderate pain; fever; prophylaxis of transient ischemic attacks and MI

  10. Treatment: • Medications • -Administer meds (aspirin for example) • Monitor Vitals/Labs • -pulse, blood pressure, note heart sounds • -BUN, Creatinine, etc. • Patient education • -educate patient of signs and symptoms of heart attacks and proper measures • -following a healthier diet • -being physically active/ maintaining a healthy weight

  11. Research Article #1 The Relationship between Knowledge and Risk for Heart Attack and Stroke Background: “Stroke and myocardial infarction (MI) represent 2 of the leading causes of death in the United States. The early recognition of risk factors and event symptoms allows for the mitigation of disability or death. We sought to compare subject knowledge of stroke and MI, assess subject risk for cardiovascular disease, and determine if an association exists between knowledge and risk.” Method: In this cross-sectional survey, adult, non–health care professionals were presented with a written knowledge test and risk assessment tool. Subjects were classified into 3 categories of cardiovascular risk. Associations were then calculated between knowledge, risk, and population demographics. Results: Of 500 subjects approached, 364 were enrolled. The subjects were mostly white, middle-aged, and high school educated. Gender and income were evenly distributed. Forty-eight (14%) subjects were identified as ideal risk, 130 (38%) as low risk, and 168 (49%) as moderate/high risk.MI and stroke knowledge scores decreased as cardiovascular risk increased(85%, 79%, and 73% for ideal, low, and moderate/high risk groups, respectively; P < .001).In addition, regardless of risk category, stroke knowledge scores were always lower than heart attack knowledge scores. Conclusion: Knowledge about stroke and MI was modest, with knowledge of MI exceeding that of stroke at every level of risk. Subjects with higher risk were less knowledgeable about the stroke signs, symptoms, and risk factors than those of MI.

  12. Reference: Cameron, L., Seth, V., Frances, S., & Jane, B. (n.d). The Relationship between Knowledge and Risk for Heart Attack and Stroke. Journal Of Stroke And Cerebrovascular Diseases, doi:10.1016/j.jstrokecerebrovasdis.2012.02.002

  13. Research Article #2 Ethnic and gender differences in patient education about heart disease risk and prevention Purpose To investigate whether there are gender and ethnic disparities in the patient education provided by primary healthcare providers about heart disease (HD) risk and prevention. Methods A telephone survey, conducted in four languages, was completed by 976 people, 40+ years of age, in Metro Vancouver, Canada. Questions assessing communication with healthcare providers’ provision of HD risk and management education were the focus. The questionnaire included 71 questions, and of those, four questions were the focus of this study: ‘‘Has your doctor or another health care provider, such as a nurse or health educator, ever talked to you about: 1. How you might reduce your risk of having a heart attack? (Yes or No) 2. The signs and symptoms of a heart attack? (Yes or No) 3. What to do if you experience symptoms of a heart attack? (Yes or No) 4. Your personal risk of having a heart attack? (Yes or No)’’ Results Statistically significant gender and ethnic differences were found. Women were less likely to report discussing HD risk and management with their healthcare providers. Chinese-Canadian participants had less likelihood of receiving HD education compared with participants of other ethnic origins. These differences persisted after multivariate adjustment with income, highest level of education attained, age, and other factors. Conclusion The findings of our study are of concern given that heart disease is a leading cause of death for women in Canada. Primary healthcare providers should make improved efforts towards education about HD and its risk factors for women in general, and for postmenopausal women especially.

  14. Reference GilatL., G., Pamela A., R., Paul M., G., & Shahadut, H. (n.d). Patient Education: Ethnic and gender differences in patient education about heart disease risk and prevention.PatientEducation And Counseling, 76181-188. doi:10.1016/j.pec.2008.12.026

  15. Nursing Diagnosis:Risk for injury r/t loss of sensation.

More Related