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Anatomy and Physiology 2 Lab Name ________________________________

 

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Case Study Assignment. You are a medical student working your way through college and are assigned to a hospital given background information on a patient. You were provided the chief complaint and brief history of the patient outlined below. You are asked by the nurse in charge to read the following case, investigate the topic (Cardiovascular Issue) and complete a written report in MLA format including references addressing each of the questions identified below. Use this link for guidance on MLA writing format: https://owl.purdue.edu/owl/research_and_citation/mla_style/mla_formatting_and_style_guide/mla_general_format.html

Total length of your report should be about two-three pages typed. The purpose of this assignment is to put things you are learning in the course (lecture and lab) into context using real life situations. This assignment’s focus is to investigate real issues of the of the cardiovascular system and related tissues.

 

Chief Complaint: 76-year-old female admitted to the ER with shortness of breath and swelling.

History: While at home, Helen Johnson, a 76-year-old female, was getting out of bed to investigate a noise in the house. Helen had been noticing that lately, she had been having increasing shortness of breath (dyspnea) even when walking short distances. She has also noticed that the swelling in her ankles has been getting worse over the past three months. Hellen decided she must go to the ER and presented her history to the physician. She recounted that in her twenties, she had rheumatic fever and also stated her current health situation of increasing shortness of breath upon exertion and swelling in her ankles. She was most concerned with the swollen ankles as it made it difficult for her to get her shoes on at the end of the day. In the past week, she’s had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.

On physical examination, Hellen’s jugular veins were noticeably distended. Auscultation of the heart revealed a low-pitched, rumbling systolic murmur, heard best over the left upper sternal border. In addition, she had an extra, “S3” heart sound. A chest X-ray revealed a cardiac silhouette with a normal diameter. When you examined Hellen’s abdomen, you find that her liver is enlarged with a moderate degree of ascites. Hellen’s ankles revealed significant “pitting edema” and is advised to wear support stockings. Based on the examination, the physician starts Hellen on the medication digoxin.

Two weeks after starting digoxin, Hellen returns to the physician’s office for a follow-up visit. On physical examination, she still has significant hepatomegaly and pitting edema, and is significantly hypertensive (i.e. she has high blood pressure). Her physician prescribes a diuretic called furosemide (or “Lasix”).

 

 

Items to address in your report.

1. Explain to your supervisor your summary of the patient’s complaint and background history.

2. In your report, be sure to address all the specifics about the findings of the examination. For example, what is causing the murmur, what is an S3 heart sound and what is causing it, etc.)

3. In your report address and explain what you researched about the relevance of rheumatic fever found in the patient history.

4. Based on the chest X-ray, do you think this rules out a possible problem with Hellen’s heart. Explain.

5. What is the importance of the finding of enlarged liver and moderate degree of ascites? Explain these findings.

6. Explain the significance of finding “pitting edema” two weeks after starting her medication.

7. Explain why wearing support stockings is expected to help her.

8. Which term do you think more accurately describes the stress placed upon Hellen’s heart – increased pre-load or increased afterload?

9. Explain what you believe is the general term describing Hellen’s condition and how might her body compensate for the condition.

10. Hellen was started on a medication digoxin. Why was she given this medication and how does it work?

11. At the two-week exam, why did the physician prescribe “Lasix” and how does it work?

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