Data CollectionStudent Assignment Date(s) of Gend Name: Jennifer Carey #: Care: 12/14/11 er MF Age Neonate 80 Allergies Admission Code : NKA Date: 2/4/2011 Status: DNR Primary Medical Diagnosis Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD) Comorbiditie s: Depression, Atrial Firbrilation (A fib), Diabetes Mellitus type 2, Hypertension, Chronic, senile dementia iron deficiency anemia, Constipation, lumbar degenerative joint disease, Coronary Artery Disease (CAD) Developmental Stage: Pathophysiology of above conditions: Name: Diabetes Mellitus II Patho: In type 2 diabetes, the pancreas continues to produce some insulin, it is just not enough for the bodys needs or it is used poorly by the body tissues (Corwin, 2008). Etiology: Insulin resistance, decreased pancreatic production of insulin and inappropriate glucose production by the liver all play a role in developing type 2 diabetes (Corwin, 2008). S/S: Usually nonspecific and include fatigue, recurrent infections, prolonged wound healing and vision changes (Corwin, 2008). R/T Meds: None Name: Chronic Obstructive Pulmonary Disease COPD is a disease in which an airflow obstruction caused by chronic bronchitis of emphysema is present. Usually a progressive, non-reversible (completely) condition. There is inflammation also. Chronic bronchitis is defined as a chronic productive cough for at least 3 months in 2 or more years. Emphysema is an abnormal permanent enlargement of the airspaces with structural changes (Lewis, Heitkemper, & Dirksen, 2000). Patho: Emphysema: 2 types: centrilobular and panlobular. In centrilobular, the primary area of involvement is the central part of the lobule. Respiratory bronchioles enlarge, the walls are destroyed, and the bronchioles become confluent. Chronic bronchitis is often associated with centrilobular emphysema which is more common. Panlobular involves distention and destruction of the whole lobule. Bronchioles, alveolar ducts and sacs, and alveoli are all affected. There is a progressive loss of lung tissue and a decreased alveolar-capillary surface area. Chronic bronchitis: an excessive production of mucus in the bronchi accompanied by a recurrent cough. Structural changes include hyperplasia of mucous-secreting glands in the trachea and bronchi, increase in goblet cells, disappearanceRevised September 2011Page 1 of 17

of cilia, chronic inflammatory changes and narrowing of the small airways and altered functioning of alveolar macrophages leading to more infections (Lewis, Heitkemper, & Dirksen, 2000). Etiology: Cigarette smoking is the primary cause of COPD and is true for this client. Other etiologies include recurrent respiratory tract infections, high levels of air pollution, heredity and aging (Lewis, Heitkemper, & Dirksen, 2000). S/s: Emphysema: Dyspnea on exertion that becomes progressively worse, Coughing with no sputum to little sputum, flattened diaphragm leading to barrel chest, chest breathing, hypoxemia, hypercapnia late in disease, thin and underweight, finger clubbing (Lewis, Heitkemper, & Dirksen, 2000). R/T Meds: Name: Hypertension is a sustained elevation in BP. When systolic pressure is greater than 140 or diastolic pressure is greater than 90. Diagnosis of hypertension comes when elevated readings occur on 3 consecutive occasions during several weeks. High BP means the heart is working hard, putting the heart and the vessels under stress (Lewis, Heitkemper, & Dirksen, 2000). Patho: An increase in cardiac output or systemic vascular resistance (SVR) must occur for pressure to rise. The true diagnosis of hypertension comes when there is a persistence elevation is SVR (Lewis, Heitkemper, & Dirksen, 2000). Etiology: Heredity, Water and sodium retention, altered renin-angiotensin mechanism, stress, insulin resistance, smoking, race, sex and age are some causes of hypertension (Lewis, Heitkemper, & Dirksen, 2000). S/s: None at first. Usually a patient seeks medical attention because of secondary issues hypertention causes or the high BP effects on organs like CAD (Lewis, Heitkemper, & Dirksen, 2000). R/T Meds: Name: A fib Patho: Total disorganization of atrial electrical activity wo effective contraction (Lewis, Heitkemper, & Dirksen, 2000). Etiology: Can be chronic or intermittent. Usually pt has underlying cardiac disease (Lewis, Heitkemper, & Dirksen, 2000). S/S: R/T Meds: Coumadin Name: CAD is a blood vessel disease that is included in the general category of atherosclerosis (Lewis, Heitkemper, & Dirksen, 2000). Patho: Characterized by a deposit of cholesterol and lipids in the arterial wall (Lewis, Heitkemper, & Dirksen, 2000). Etiology: The exact cause is unclear. No single theory fully explains the process. Two theories: lipid hypothesis and chronic endothelial injury hypothesis. Lipid hypothesis states a high lipid level promotes lipid penetration of the arterial walls. When LDLs undergo oxidation, they become harder to mobilize and locally cytotoxic. Damage to the endothelial layer makes the damaged site more permeable to plasma components (Lewis, Heitkemper, & Dirksen, 2000).Revised September 2011Page 2 of 17

S/S: most common: angina (Lewis, Heitkemper, & Dirksen, 2000). R/T meds: Name: Congestive Heart Failure (CHF) is a cardiovascular condition in which the heart is unable to pump adequate amounts of blood to the bodys tissues (Lewis, Heitkemper, & Dirksen, 2000). Patho: Interference with cardiac output (Lewis, Heitkemper, & Dirksen, 2000). Etiology: CAD and advanced age are the biggest risk factors. Hypertension, diabetes, cigarette smoking, obesity, high cholesterol and proteinuria are other factors. CHF increases with the severity of the HTN. Systolic and Diastolic htn equally predict risk. CHF may be caused by any interference with the normal mechanisms regulating cardiac output (Lewis, Heitkemper, & Dirksen, 2000). S/S: R/T Meds: Name: Constipation is a decreased frequency of bowel movements for what is normal for the client (Lewis, Heitkemper, & Dirksen, 2000). Patho: May be hard stools. Stools may be hard to pass. There may be a decrease in the amount of stool (Lewis, Heitkemper, & Dirksen, 2000). Etiology: Can be due to insufficient fiber in the diet, decreased fluid intake, medication use (like pain meds), and lack of activity (Lewis, Heitkemper, & Dirksen, 2000). S/S: no BM, hard stools (Lewis, Heitkemper, & Dirksen, 2000). R/T meds: MOM Name: Senile Dementia causes cognitive impairment Patho: Loss of neurons. Atrophy of the brain. Progressive. Leads to death. Loss of cholinergic nerves especially in the memory area. Etiology: Still unclear, but age plays a roll. There may be a genetic factor. S/S: Loss of memory that is progressive, unable to learn new things, some patients get psychotic symptoms. Eventually even long term memories are gone. (Lewis, Heitkemper, & Dirksen, 2000) R/T meds: None Name: Osteoarthritis (OA) AKA Degenerative Joint disease (DJD) is a slowly progressing disorder of articulating joints, especially weight bearing ones, characterized by degeneration of articular cartilage. Patho: Degenerative changes over time cause the normally smooth, white, translucent joint cartilage to become yellow and opaque, with rough surfaces and areas of softening. As the cartilage becomes thinner, the bony surfaces of a joint come closer together. There may be inflammation in the synovial membrane. Etiology: Primary cause is unknown. Primary and secondary are influenced by many factors including metabolic, mechanical, genetic and chemical. Secondary OA could be caused by previous trauma, fractures, infections, orRevised September 2011Page 3 of 17

congenital deformities. S/s: Joint pain, stiffness, and limited range of motion. (Lewis, Heitkemper, & Dirksen, 2000) R/T Meds: Norco for pain Name: Anemia (Iron Defeciency) Patho: Iron makes up a large part of a red blood cell (RBC). Etiology: Low dietary intake of iron or slow blood loss S/S: Low hemoglobin, pale palms, pale conjunctivae, pale earlobes (Corwin, 2008). R/T Meds: Ferrous Sulfate Name: Depression Patho: Etiology: S/S: R/T Meds: CelexaCourse-specific data attached

Laboratory TestsDate12/6/11 10/18/11

Time0600 1048

Abnormal/Significant Lab FindingsINR 2.2 CO2 34 mmol/L

Normal range per Facility/Lab2-3. Critical is 4-5 or higher 22-31 mmol/L

How does the result relate to the pathophysiology of your patients condition(s)?Client is therapeutic with current dose. This result is consistent with clients COPD/CHF diagnoses. Client has poor CO2 excretion by the lungs or an inadequate respiratory drive (Malarkey & McMorrow, 2005). Client has a type 2 diabetes diagnosis with this confirms. According to Malarkey and McMorrow, though, an elderly person is allowed to have a glucose of 80-150 mg/dL (2005). B-type Natriuretic Peptide: Differentiation between cardiac and

4/14/11

Unk

Glucose 125 mg/dL 70-99 mg/dL

BNP 191 pg/ml