Assignment
Patient Profile
D.B., a 61-year-old woman, presents to the emergency department after fainting in the grocery store. She has a history of gastroesophageal reflux disease and hypertension. She is currently taking the following medications:
1) Omeprazole 20 mg PO daily before breakfast
2) Captopril 50 mg PO twice daily
Subjective Data
1) States that all she remembers is that she was grocery shopping and felt some palpitations in her chest, shortness of breath, and dizziness. The next thing she knew, paramedics were putting her in an ambulance.
Objective Data
Physical Examination
1) Blood pressure 142/80, pulse 104, temperature 98.7°F, respirations 18
2) Heart rhythm regular with a grade II/VI murmur
3) Lungs have crackles in bilateral bases
4) Alert and oriented, cooperative
Diagnostic Studies
1) 12-lead ECG shows sinus tachycardia of 104, regular rate, no ST elevation or ectopy
2) Lab values
3) CBC
a. Hemoglobin 15 g/dL
b. Hematocrit 45%
c. WBC 10,100/µL
4) Electrolytes
5) Sodium 139 mEq/L
6) Potassium 3.6 mEq/L
7) CO2 25mEq/L
8) Chloride 99mEq/L
9) Cardiac markers
a. CK-MB 2%
b. Troponin T 1ng/mL
c. Troponin I 05 ng/mL
10) Cardiac natriuretic peptide markers
a. B-type natriuretic peptide (BNP) 110 pg/m
• When performing a cardiovascular assessment, what additional information regarding auscultation of the heart is important to document?
• If D.B. has mitral valve stenosis, where would it best be heard upon auscultation of the heart and with what part of the stethoscope?
• Based on the clinical manifestations that brought D.B. to the emergency department, the health care provider suspects she may also have a dysrhythmia, so he orders Holter monitoring. He also orders an echocardiogram. Explain why these two diagnostic studies are ordered.
• What physical examination assessment(s) can be done to assess for the presence of atrial fibrillation?