*NURSING > CASE STUDY > Case Study Pharmacology Reasoning, Bradycardia, Suggested Answer Guidelines, Marilyn Fitch, 78 years (All)
Initial Presentation: Marilyn Fitch is a 78-year-old Caucasian woman with a history of hypercholesteremia, hypertension, and heart failure and has NKDA. She was brought in by her daughter after Mari... lyn complained of feeling dizzy several times this morning and then almost passed out at home. Marilyn has a six-month history of paroxysmal atrial fibrillation. Her heart rate has been regular and she has had no episodic dizziness since she had a synchronized cardioversion one week prior to this visit. Her initial VS in triage were: T: 98.9 F/37.2 C (oral) P: 52 R: 16 BP: 94/52 and O2 sat: 98% room air. Personal/Social History: Marilyn is a widow and lives alone in her own home. She denies smoking and admits to drinking one glass of wine with her dinner. 1. What data from the histories are RELEVANT and must be NOTICED as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: Hypercholesterolemia Hypertension Heart failure Dizziness/ almost passing out 6-month paroxysmal A fib Synchronized cardioversion Pulse of 52, BP 94/52 All of these are risk factors (especially when combined) for heart attack and stroke Concerning signs of heart rhythm changes Vitals of low HR and Low BP, usually if one of these two vitals changes, the other will increase to compensate. RELEVANT Data from Social History: Clinical Significance: Widow and lives alone Drinking wine with dinner Shows the pt doesn’t have much of a support system, and there could be psychosocial aspects to include in her care Drinking 1 glass of wine with dinner is usually ok, in a healthy individual. Since she has heart problems, cholesterol issues and hypertension,..........................................continued [Show More]
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