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J.T. is a 58-year-old Tongan man admitted to your floor with syncope and right-sided heart failure.

J.T. is a 58-year-old Tongan man admitted to your floor with syncope and right-sided heart failure. . Question
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Asked by MinisterTrout2412

J.T. is a 58-year-old Tongan man admitted to your floor with syncope and right-sided heart failure. He was brought to the hospital after “passing out” and “turning blue” for 2 minutes after a severe bout of coughing. Because J.T. speaks very little English, his wife helps you obtain his health history: NIDDM, significant abdominal obesity, hypertension, CHF, chronic hypoxia, frequent pneumonia, hyperlipidemia, and polycythemia. His wife tells you he snores loudly and seems to stop breathing sometimes during the night. He has no history of smoking or alcohol use. His weight is 310 pounds. Over the last week he has had intermittent chest pain with shortness of breath on exertion. The shortness of breath has increased during the last 12 hours. He has been hospitalized in the past for chest pain but has never had an MI. On admission today he has orthopnea, a severe dry cough, palpitations, and shortness of breath. He is not complaining of chest pain or discomfort. His VS are 146/94, 64, 20, 36.7°C. You hear muffled S, and S, heart sounds and a possible S,. He has moderate pretibial edema to his knees and a few bibasilar crackles. You place him on oxygen at 3 L/min by nasal cannula and insert a Foley catheter. His blood glucose level is 147 mg/dl and Hct is 50%. Other lab values are normal, including cholesterol and triglyceride levels.

 

1. What is the relationship of J.T.’s country of origin to his current health problems?

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2. What do you think is the significance of J.T.’s wife’s report about his snoring and sleep-related breathing pattern?

 

3. Judging from the admission information, do you think he has right-sided CHF, left sided CHF, or both? Cite your evidence.

 

4. List 3 other things you could assess to confirm your suspicion of right-sided failure.

 

5. What is a possible explanation for his chronic hypoxia?

 

6. List 4 priority nursing diagnoses for J. T.

 

The night shift nurse confirms the report that J.T. snores loudly (“I could hear him all the way down the hall!”) and has 30- to 60-second pauses in his breathing followed by a violent jerk and thrashing as he resumes inspirations. A sleep study is ordered.

 

7. Define a sleep study and what information can be obtained from it.

 

The sleep study showed obstructive sleep apnea with oxygen desaturation as low as 32% for prolonged periods following each apneic episode. During his study, J.T. had over 320 apneic episodes in 1 night.

 

8. Continuous positive airway pressure (CPAP) is prescribed for J.T. Explain the concept of CPAP and how it will benefit him.

 

On the forth day after admission, J.T. developed chills and fever with a temperature of 38.5°C and an SaO2 of 88% on 3 L 0₂/nc.

 

9. What are the 2 most likely sources of infection that might be responsible for his fever?

 

J. T. was diagnosed with pneumonia and started on erythromycin. During his hospitalization, J.T.’s family has repeatedly brought him food and drinks from home in spite of explanations by the nurses that he is on a 2000-calorie, low-salt, diabetic diet, and on fluid restriction. Because of his obesity and extreme shortness of breath on exertion, he is quite immobilized. 

 

10. Identify the most serious complication of immobility for which he is at risk, and state the reasons for this risk.

 

After a week on erythromycin for his pneumonia and diuresis for his CHF, J.T.’s doctor says he is ready to go home. You have developed a list of things that you think he and his family should be taught before he is ready for discharge. After reviewing his history, you have decided that he has many risk factors for coronary artery disease; although he has not had an MI yet, he is at risk for having one. You have placed teaching about cardiac risk factors at the top of your list.

 

11. List 4 cardiac risk factors that J. T. has and place a check () mark beside the ones that are potentially modifiable through behavioral change..

 

Note: Although polycythemia is uncommon and is not on the list of usual coronary risk factors, it increases the tendency for clot formation and increases the risk for MI. 

 

12. Identify 2 major pathologic conditions J.T. has for which he needs teaching.

 

13. What do you think is the likelihood J.T. will be motivated to exercise and diet to lose weight and why?

 

SCIENCE
HEALTH SCIENCE
NURSING
NURSING VN114

J.T. is a 58-year-old Tongan man admitted to your floor with syncope and right-sided heart failure.

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