Respiratory Case Study Question (NO EXTERNAL Reference Required
Use the attached case study to answer the questions below.
NOTE: All answers must come from the attached case study, NO other reference or external sources is needed. You must justify your reasoning based on the content of this case study only.
1 – 1.5 pages is good enough
QUESTION:
How might Jerry's bout of flu Short period of time) contributed to his
current presentation? What is the significance of his irregular heart rate? What
might this be and how could it have developed? How might it contribute to his
current condition?
Meet the Wanamaker Family
Family Presentation
Jerry and Stan Wanamaker have been in a committed relationship for 15 years and have been married for the last three years. Stan works as a successful stock broker while Jerry, a former teacher, is retired and on disability due to chronic heart disease. They live in a comfortable apartment on Long Island, New York. Jerry’s mother, Esma, lives nearby in an assisted living facility. Kaylah, Stan’s daughter, attends New York University and lives with a roommate on-campus. They are a close family, frequently getting together for holidays and special events.
Family health history
Jerry was successfully treated for acute promyelocytic anemia 15 years ago, however he developed heart failure as a side effect of the chemotherapy used. Jerry’s father had COPD and dementia. He passed away from pneumonia 2 years ago. Stan is healthy, but suffers frequent migraines. His parents have both passed away. His mother had a history of rheumatoid arthritis and kidney stones. His father had a history of hyperlipidemia and type II diabetes. His father passed away from renal failure, while his mother passed away last year after suffering a fall and hip fracture. Esma is an active senior, who experienced a CVA 10 years ago with no apparent residual effects. Since that time, she has been on a statin and has had no further cerebrovascular events. Kaylah is a healthy college student who, aside from the occasional cold, has no medical issues.
Meet the Family Members
Jerry Wanamaker:44 years old, healthy. Suffers from chronic heart failure. History of acute promyelocytic leukemia15 years ago. Lactose intolerant. Smoked cigarettes for 10 years, approximately 1/2 pack per day. Quit smoking in his early 30s.
Stan Wanamaker:47 years old, with a history of migraines and irritable bowel syndrome.
Esma Stein:80 years old, history of osteoporosis, hypertension, chronic back pain, cataracts, and CVA with no residual deficits.
Kaylah Wanamaker:21 years old, healthy with no significant medical history.
Cardiac Case Study- Jerry Wanamaker
History of Current Problem
Jerry is just getting over a bout of influenza and has been feeling better this week. However, he has not been able to fully “get back to normal”. Yesterday, he became short of breath from climbing two flights of stairs. He also woke up last night gasping for air. He has been weighing himself, and he state that he has not put on any extra weight. However, he has had a dry cough throughout the day. He took his blood pressure and found it was 156/92 mmHg. He decided to come to the office, given his medical history.
Additional Past Medical History
Remember to review the family’s medical history in the introductory presentation. In addition, recall that Jerry is still getting over the flu.
Objective Exam
System
Findings
General
Alert, oriented, slightly pale,
Vitals
Temp: 97.8 F, Pulse 96, RR 22 per minute, BP 162/96. O2 sat. is 92%. Weight is 81 kg.
Skin
Cool, pale, diaphoretic.
HEENT
Normocephalic. Eyes show no discharge or drainage. Nose exhibits clear rhinnorhea.
Respiratory
Symmetrical chest expansion. Bibasilar rales with auscultation. No use of accessory muscles or nasal flaring. A-P ratio is 1/2.
Cardiovascular
No murmurs noted. Heart rate is irregularly irregular. S1 is of varying intensity Distinct S3 gallop noted at apex. RRR. No clubbing, cyanosis, or edema noted. 1+ pulses in all extremities. PMI is laterally displaced. JVD present
Lymphatic
Negative for lymphadenopathy
Abdomen
Soft, slightly distended. hypoactive bowel sounds. No tenderness or hepatosplenomegaly noted during palpation
Genitourinary
No abnormal findings
Neurological
Alert and oriented x3
Diagnostic testing:
Chest X-ray
BNP
Echocardiogram
BNP: 750 pg/mL
EF: 39%. Echo demonstrates cardiomegaly that has not changed significantly since last echo. Last EF was 49%
Based upon these findings, the NP you are working with arrives at the following differential diagnosis:
Heart failure exacerbation