Posted: July 17th, 2022

A 64-year-old woman presents to the primary care office with shortness of breath

TOPIC:
equirements:
A 64-year-old woman presents to the primary care office with shortness of breath, leg swelling, and fatigue. She has a history of type 2 diabetes and hypertension. She reports that recently she had been able to go for daily walks with her friends, but in the past month, the walks have become more difficult due to shortness of breath and fatigue. She also sometimes awakens in the middle of the night due to shortness of breath and has to prop herself up on three pillows. On physical examination, she is tachycardic (110 beats per minute) and has a blood pressure of 106/74 mm Hg. Fine crackles are noted on inspiration in bilateral bases. The cardiac exam reveals the presence of a third and fourth heart sound and jugular venous distension. 2+ pitting edema is noted in the knees bilaterally. An ECG shows sinus rhythm at 110 bpm with Q waves in the anterior leads. An echocardiogram shows decreased wall motion of the anterior wall of the heart and an estimated ejection fraction of 25%. She is diagnosed with systolic heart failure, secondary to a silent MI.
1. Discuss the pathophysiological mechanisms that can lead to heart failure.
2. Differentiate between systolic and diastolic heart dysfunction
3. Discuss the causes of the patient’s shortness of breath, awakening in the middle of the night and the need to prop herself up on three pillows. Include pathophysiological mechanisms that causes each of these signs and symptoms.
4. Include two points of patient teaching for this patient from a nursing perspective (nurse patient education)
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5. Students must post a minimum of three times in each graded discussion (see participation guidelines below).

DISCUSSION CONTENT
Category Points % Description
Application of Course Knowledge 30 30% 1. Posts make direct reference to concepts discussed in the lesson or drawn from relevant, evidence based outside sources, AND
2. Posts are on topic and answer all presented questions which demonstrates a solid understanding of the topic.
3. Applies concepts to personal experience in the professional setting and or relevant application to real life, AND
4. Decisions are well supported with evidence-based arguments that are in-line with the scenario; AND
5. Proper rationale and reasoning skills are demonstrated; AND
6. Information is taken from source(s) with appropriate interpretation/Assessment to develop a comprehensive analysis or synthesis of the topic
Support From Evidence Based Practice 30 30%
1. Discussion post is supported with appropriate, scholarly sources; AND
2. Sources are published within the last 5 years (unless it is the most current clinical practice guideline (CPG); AND
3. Reference list is provided and in-text citations match; AND
4. Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions

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