NSG 5003 Week 3 Case Study

NSG 5003 Week 3 Case Study

NSG 5003 Week 3 Case Study

Case Study 1

Cause of Ventricular Septal Defect

The American Heart Association defines ventricular septal defect as an opening in the septum (American Heart Association [AHA],2022.). Normally, the opening in the septum closes before birth to prevent the mixing of oxygenated and deoxygenated blood. Failure of the opening to close results in an increase in blood pressure and decrease in body’s oxygenation due to lung congestion. Symptoms rarely appear until 14 days of life when audible murmur is heard due to the shunting of the blood attributed to differences in ventricular and atrial pressures (PVR) (AHA, 2022).

What Problems Will Baby Have

Children affected by ventricular septal defect present with symptoms that include cyanosis. The level of cyanosis depends on the severity and complicated nature of the defect. A murmur is also heard on auscultation. Babies also experience tachypnea, lethargy, fatigue, and are tachycardic if the defect is severe. These symptoms develop because of the increased demands for oxygen that the circulatory system cannot meet. Infants also have difficulties in feeding due to lack of energy as well as stunted growth (Lucie Dlugasch; Lachel Story &, 2019).

How Effect Will Create Problems

Ventricular septal defect is associated with considerable health problems. Besides the above, it can increase pulmonary pressure to cause pulmonary hypertension. Pulmonary hypertension affects the overall body tissue perfusion. Delayed treatment of the defect can also damage the blood vessels. The damage arise from increased vessel resistance, reduced blood flow, and persistent hypoxemia, which affect the normal blood vessel functioning (Lucie Dlugasch; Lachel Story &, 2019).

Diagnostic Test

The diagnostic approaches to ventricular septic defect includes obtaining comprehensive history of the problem. Physical examination also helps identify abnormal findings such as murmur and cyanosis. Additional investigations include echocardiogram, chest x-ray, magnetic resonance imaging (MRI), cardiac catheterization, and cardiac magnetic resonance imaging (CMRI) (Lucie Dlugasch; Lachel Story &, 2019).

Treatments Baby Will Need

Treatment approaches to ventricular septic defect depends on its severity. For example, tiny ventricular septic defect with no or mild symptoms may not require treatments such as surgery. Minor defects close by themselves as the child grows (AHA, 2022). Temporary procedures may be required for symptom relieve if the infant is extremely sick or has multiple heart defects. Surgical interventions are used to reduce pulmonary artery blood flow. A surgical band may also be used to narrow pulmonary artery and give more time for child’s growth until the age where they can withstand permanent surgical procedures (AHA, 2022).

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NSG 5003 Week 3 Case Study References

American Heart Association. (2022, March). Ventricular septal defect (vsd). www.heart.org. Retrieved October 7, 2022, from https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/ventricular-septal-defect-vsd

Lucie Dlugasch; Lachel Story &. (2019). Applied pathophysiology for the advanced practice nurse (1st ed.). Jones & Bartlett Learning.

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Week 3 Case Study

Directions

All students should complete one (1) case study below. Note: All case studies are provided as a learning tool for students who wish to have them.

Case 1

You are examining a 5-week-old infant and hear a systolic murmur at the lower left sternal border. You suspect a ventricular septal defect. The parents are concerned and have several questions.

Answer the following questions based on this scenario.

What is the cause of a ventricular septal defect?
What problems will our baby have due to his VSD?
How does the defect create these problems?
What diagnostic tests will be ordered?
What treatment will our baby need?

Case 2

Mr. Delano comes in to discuss the results of cardiovascular diagnostic tests. He is a 61-year-old White man with no complaints. Past medical history: left hip osteoarthritis and gout; Past surgical history: none; Allergies: none known; Medications: allopurinol 100 mg by mouth once a day; Social history: one to two alcoholic drinks three times a week; smokes one cigar every other month; exercises for 1 hour six times a week; retired nurse—works per diem at hospital once a week; Family history; mother, father, and one bother with hypertension; one brother with dyslipidemia.

Physical exam: vital signs – temperature 98.5°F; pulse 60 beats per minute; respirations 20 per minute; and blood pressure 134/67 mmHg; height 180 cm; weight: 85.5 kg; body mass index 26.3; physical exam unremarkable.

See cardiovascular diagnostics table in the text on page 157.

Answer the following questions based on this scenario.

Which of the cardiovascular diagnostic values demonstrate dyslipidemia and risk for atherogenesis?
Interpret and describe lipoprotein subfractions and apolipoproteins results.
Which of the cardiovascular diagnostic values are in the cardioprotective range?
What lifestyle recommendations, such as diet and exercise will be made based on these results?
What is his ASCVD risk score? What parameters (e.g., blood pressure) are used to calculate the risk score?

Case 3

Compare the following two (2) scenarios.

Scenario 1: Mr. Fernandez is a 62-year-old man who comes into the clinic complaining of left lower leg swelling that started 5 days ago. He says the leg hurts but mainly when he walks and does not get better after rest. He denies any trauma or fever. He returned from an international trip 2 days before the swelling started. He is healthy except for hypertension, which is well controlled with a daily thiazide diuretic.

Scenario 2: Mr. Kraft is a 65-year-old man who comes in complaining of lower leg pain that he has had for the past 3 months. He says both his legs cramp up in his calves when walking. He sits down to rest and the cramps go away. He denies any trauma or fever. He has smoked 1 pack of cigarettes a day for the past 35 years. He has type 2 diabetes for which takes metformin twice a day.

Answer the following questions based on these two (2) scenarios:

In which scenario are the history and findings consistent with a venous disorder and which is consistent with an arterial disorder?
What are the most likely venous and arterial disorder diagnoses?
Describe the pathogenesis of these venous and arterial disorders.
What would be expected physical examination findings with a venous disorder and which with an arterial disorder?
Which diagnostic tests and treatment are indicated for a venous disorder?
Which diagnostic tests and treatment are indicated for an arterial disorder