Case Study Essay

950 Words May 9th, 2011 4 Pages
Case Study #5
Heart & Neck Vessels, Lungs & Thorax
Mrs. Lee, 80 year old Asian American female
Admitted to the medical-surgical unit with a chief complaint of “breathing problems”. She speaks broken English & requests that her daughter be allowed to stay with her. She is on nasal cannula oxygen & sitting up in bed. At this time, she seems slightly short of breath, but is not in acute distress. You note that she is pale & has a petite frame. Her ankles are swollen. Her daughter tells you that she has been complaining of feeling more tired in the evenings & “unable to catch her breath”. While at home, she has been sitting up either in an easy chair or in bed with three pillows. Her daughter states that Mrs. Lee has not had to
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Assess each sound you hear separately.
6. Mrs. Lee has a positive hepatojugular reflux. Describe the procedure for checking hepatojugular reflux & the significance of this finding.
Position the patient supine (if tolerated) & instruct her to breathe quietly through her open mouth. Hold your right hand on the right upper quadrant of the person’s abdomen. As you push in with your hand, hold firm, sustain pressure for 30 seconds. Observe the level of jugular pulsation as you push in with your hand. This maneuver empties venous blood from the liver & adds the extra volume to the venous system. If the heart is unable to pump this additional volume, then the jugular veins will elevate & stay elevated as long as you are pushing. This finding indicates the presence of heart failure.
7. Does this patient have a pulse deficit? If so, what could this indicate? Normally, the apical beat & radial pulse should be nearly identical when counted immediately after each other. The pulse deficit is 16 to 18. A pulse deficit indicates a weak contraction of the ventricles & can occur with conditions such as heart failure, premature beats, & atrial fibrillation.
8. Based on your assessment, what condition do you suspect? Support your answer.
Congestive heart failure is the heart’s inability to pump sufficient blood to meet the demands of the body. Several of the assessment findings suggest this, including dyspnea, tachycardia, jugular vein distention,

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