Your patient, 58-year-old K.Z., has a significant cardiac ...

[haleyc112]

Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing coronary artery disease (CAD) with occasional episodes of heart failure (HF). One year ago, he had an anterior wall myocardial infarction (MI).
 
  In addition, he has chronic anemia, hypertension, chronic renal insufficiency, and a
  recently diagnosed 4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD, he had to
  retire from his job as a railroad engineer about 6 months ago. This morning, he is being admitted to your
  telemetry unit for a same-day cardiac catheterization. As you take his health history, you note that his
  wife died a year ago (at about the same time that he had his MI) and he does not have any children. He
  is a current cigarette smoker with a 50pack-year smoking history. His vital signs (VS) are 158/94, 88, 20,
  and 97.2  F (36.2  C). As you talk with him, you realize that he has only a minimal understanding of the
  catheterization procedure.
 
  Before he leaves for the catheterization laboratory, you briefly teach him the important things
  he needs to know before having the procedure. List five priority topics you will address.
 
  Look at his past history. What other factors are present that could contribute to his risk for
  cardiac ischemia?

Question 2

Your hospital discharge planner facilitates J.F.'s transition to home care. During the initial home visit, the home health nurse evaluates J.F.'s IV site for implementation of the IV therapy program.
 
  The nurse interviews the family members to determine their willingness to be caregivers and their level of understanding
  and enlists the patient's and family's assistance to identify goals.
 
  The home health nurse also writes short- and long-term goals for J.F. and her family. Identify
  two short-term and three long-term goals.

[essyface1]

Answer to Question 1

 The purpose of the procedure
 How he will be prepared for the procedure
 What to expect during the catheterization itself (what the cathlab will look like; sensations he may
feel during the procedure, such as a feeling of heat or a hot flash, or palpitations; that someone will
be applying pressure to the groin to prevent bleeding after the procedure)
 What routine monitoring to expect after the procedure, and that he will have to stay in bed for 4 to
6 hours after the procedure, with the procedure leg flat and possible pressure with a sandbag over
the insertion site
 Which staff members will be present to support him
 Possible complications, and how they will be prevented or managed

Factors that may contribute to a higher risk for cardiac ischemia are K.Z.'s chronic anemia and his
smoking, which causes vasoconstriction and maintains a higher level of circulating carbon monoxide
in his red blood cells (RBCs).

Answer to Question 2

Short-term goals:
 J.F. receives ordered solution and medications without complications.
 J.F. has a patent PICC line.
 J.F.'s family is able to support her care at home.
Long-term goals:
 Vital signs are normal (afebrile).
 Infection is resolved.
 Adequate hydration is achieved.
 Fluid and electrolyte status is within normal limits for J.F.
 Renal function is restored (failure resolved).
 Cardiac function is restored (failure resolved).

[haleyc112]

Thank you

[essyface1]

No problemo