Problem
You are a nurse at a free-standing cardiac prevention and rehabilitation center. Your new client in risk-factor modification is BJ, a 37-year-old traveling salesman, who is married and has 3 children. During a recent evaluation for chest pain (including a cardiac catheterization), he was diagnosed with angina pectoris, given a prescription for SL nitroglycerin, told how to use it, and referred to your cardiac rehabilitation program for sessions 3 days a week. BJ's wife comes along to help him with healthy lifestyle changes. You take the following nursing history: BJ's father died of sudden cardiac death at age 42 and his mother (still living) had a CABGx4 (quadruple coronary artery bypass graft) at age 52; his hypertension is controlled with nifedipine (procardia) 90 mg PO qd, which he has taken regularly; he has averaged 1 ½ cigarette packs per day for 20 years; an "occasional" beer ("a 6-pack every weekend with the football game") and a dietary history of fried and fast foods. His current weight is at 235 at 5'8"; he has a waist circumference of 48 inches. His VS are 138/88, 82, 18, 98.4 degrees Fahrenheit.
a) What important information do you see in this scenario description? What information would you record on the chart?
b) What did you visualize as you read the scenario? What does the patient look like as you picture him?
c) What questions did you likely ask to get the information in the scenario?
d) What questions would you ask this patient next to gain more information?
e) Is there anything abnormal about the patient in this scenario? What is it? How might it affect your nursing diagnosis? Be as detailed as possible.
f) What is this patient at risk of?
g) How did you know?
h) Which risk factors are modifiable?
i) Which risk factors are nonmodifiable?
BJ laughingly tells you he believes in the 5 all-American food groups: salt, sugar, fat chocolate, and caffeine.
a) What does this new information tell you? Can you be certain about your analysis?
b) What questions could you ask to confirm your analysis?
c) What are some health-related problems this patient could experience? How do you know? List them in order from most dangerous to least dangerous.
d) Which of his behaviors is the biggest problem? What would you teach this patient about his behavior?