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Question.1. Mary is a 57 years of age female, who was recently diagnosed with high cholesterol after some routine bloodwork. She has diabetes mellitus Type II poorly controlled and a history of hypertension poorly controlled. Mary presented to the emergency department for epigastric discomfort described as an “ache” that has been intermittent for a couple of days. Mary has been a smoker, about 10-15 cigarettes per day for 30 years. She has been overweight most of her life and doesn’t exercise. Vital signs are: T36.8 HR 172 RR 26 BP 94/52 SpO2 92% on room air. Point of care blood sugar is 16.4 mmol/L. Color is pale, diaphoretic, increased work of breathing with tachypnea. You start the cardiac monitor and observe the following rhythm. 6 sec rhythm (The picture of ECG will attach below)Answer according to that picture. Image transcription text Answer the following: Rhythm Rate P wave PR interval QRS interval Interpretation Answer the following: Rhythm Blank 1 Rate Blank 2 P wave Blank 3 PR interval Blank 4 QRS interval Blank 5 Interpretation Blank 6 Question.2. What are the hemodynamic effects of this rhythm and possible complications if not treated? (4 marks) Question .3. What is the priority intervention? 1 Mark Question 4 The priority for this patient is to give a 250 to 500 ml bolus of normal saline to improve the blood pressure. True False Question. 5. Which of the following is not associated with the pathophysiology/causes of atherosclerosis? 1. Modifiable and non modifiable causes 2. Presence of atheromas 3. Vitamin A deficiency 4. Lipid transport involved in its development Question.6. Which of the following diagnostic tests could be used to diagnose Mrs. B’s atherosclerosis? Select all that apply. 1. Exercise stress test 2. Serum lipid levels 3. Electrolytes 4. C-reactive protein Question7 With Mary’s history, outline a) 3 modifiable risk factors associated with Coronary Artery Disease and b) 3 non-modifiable risk factors associated with Coronary Artery Disease. (3 marks each for a and b) Question 8. What conditions are included in the definition of Coronary Artery Disease? Select all that apply. 1. angina pectoris 2. arteriosclerosis 3. atherosclerosis 4. MI Question.9. Differentiate between arteriosclerosis and atherosclerosis. (2 marks) Question 10 Based on the Canadian Cardiovascular Society recommendations identify three populations that should be screened for a) CAD and b) 3 patients with which type of history who are at risk. (3 marks each for a) and b) Question11. How frequently should a cardiovascular risk assessment be conducted for men and woman over the age of 40? 1. 3-5 2. 2-5 3. 3-4 4. 3-7 Question- 12 What other lab diagnostics would you anticipate to be ordered for Mary with high cholesterol? Select all that apply. 1. Fasting lipid panel 2. urine albumin 3. Glucose 4. eGFR Q.13. When health teaching an individual diet modification which of the following will help to manage dyslipidemia. 1. partially hydrogenated vegetable fats 2. monounsaturated foods like avocados 3. polyunsaturated margarines and oils 4. saturated margarines and oils 5. cheese 6. fish Q.14. Which of the following is considered a high normal blood pressure in adults? 1. 140-159 systolic and 90-99 diastolic 2. 160-179 systolic and 100-109 diastolic 3. 120-139 systolic and 80-89 diastolic 4. <120 systolic and < 80 diastolic References Aehlert, Barbara J. (2018). ECGs Made Easy (6th ed.). E-text Mosby/JEMS Coviello, Jessica S. (2016). ECG Interpretation made Incredibly Easy (6th ed.). Philadelphia. Cohn, Elizabeth Gross, Gilroy-Doohan, Mary, (1996). Flip and See ECG. W.B. Saunders Company Kucia, A., Quinn, T. (2009). Acute Cardiac Care: A practical guide for nurses. Wiley-Blackwell, ProQuest Ebook Central Springhouse (2001). ECG Interpretation made Incredibly Easy (2nd ed). PennsylvaniaImage citations Slide #9,41,58,59,60,61,62,66,67,70,81,91,92,95,96,99,100,101,102: unknown Slide #26: https://imgur.com/gallery/a3gkASD Slide #27,28, 39: Springhouse (2001). ECG Interpretation made Incredibly Easy (2nd ed). Pennsylvania Slides #28,29: Cohn, Elizabeth Gross, Gilroy-Doohan, Mary, (1996). Flip and See ECG. W.B. Saunders Company Slides #29,30,31,32,33: https://www.stanfordchildrens.org/en/topic/default?id=anatomy-and-function-of-the- electrical-system-90-P01762 Slides #74,77: https://www.shutterstock.com/search/pr+interval. Slides #96: https://www.nurseslearning.com/courses/nrp/nrp1619/Section%203/index.htm https://www.stanfordchildrens.org/en/topic/default?id=anatomy-and-function-of-the-electrical-system-90-P01762.
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