Ms. Esposito (age 58) shares that she is third-generation Latina American. Her f

Question

Ms. Esposito (age 58) shares that she is third-generation Latina American. Her father is deceased due to a heart attack, and her mom is alive and has occasional chest pain with exertion. Ms. Esposito had fasting lab work drawn last week in preparation for this examination. As you scan the lab results, you note the following values for the lipid profile.

Total cholesterol 289 (normal 140–199), triglycerides 175 (normal 35–135), HDL 27 (normal 38–85), LDL 227 (normal < 130), and VLDL 130 (normal 25–50% of total cholesterol).

She tells you she takes a baby aspirin once daily but is healthy and on no other medications. She receives physicals annually and has her blood pressure checked by an automated machine at the grocery store. She does not smoke and only drinks wine occasionally, but her diet is rich in saturated fats and she does a small amount of exercise. She denies allergies. She works as a ticket agent for an airline, for which she is up on her feet for long stretches of time.

After the physician sees Ms. Esposito, you note that all of her laboratory results are within normal limits, with the exception of her lipid profile and her weight. After consultation with the physician, you prepare and implement a teaching plan on cholesterol reduction measures. She is to return in 3 months for a repeat lipid profile and follow-up visit. The physician has told Ms. Esposito that she may have to go on antihyperlipidemics if her lipid profile continues to show elevation. Ms. Esposito tells you she will work hard to implement these measures, because she does not want to take any medications.

What questions would you ask Ms. Esposito during a focused cardiac assessment? Explain the different techniques a nurse would use when completing a cardiac assessment on Ms. Esposito.

Discuss the developmental, psychosocial, cultural, and environmental considerations of Ms. Esposito.

State two nursing diagnoses and list nursing assessments or interventions for the diagnosis. What would you include in a teaching plan for Ms. Esposito related to lifestyle adaptations for managing CHF?

Explanation / Answer

Questions regarding their experience with respiration at rest and during exercise, exercise capabilities, signs of palpitation, headache, drowsiness, signs of edema, pain in the region of left arm and chest help to assess the cardio-vascular health.

During completing a cardiac assessment, the nurse measure blood pressure by using sphigmomanometer, read heart beat by ECG (electrocardio graph). Heart sounds can be examined by stethoscope.

Congestive heart failure (CHF) is the inability of heart to pump adequate blood according to body demands. Hypertension and coronary heart disease are the most common reasons of heart failure.

According to DASH (Dietary Approaches to Stop Hypertension) eating plan, the menu of Mr. Robert can include the following foods to reduce blood pressure and LDL cholesterol levels:

Breakfast: Whole-grain bread, cereals, pasta, fat-free muffins, fruits, egg white, and low-fat milk.

Lunch or dinner: Green leafy vegetables, lean meats fish, skinless poultry, dried beans and peas. The meats and meat-substitute products must be only 5 ounces per day.

Foods to avoid: Foods of high fat and cholesterol contents must be avoided. To get low fat intake or approximately 50g of fat per a day, the quantity of meat and meat substitutes must not exceed 6 ounces and fats and oils not exceed 2 to 3 teaspoons per a day. Foods should not contain any trans-fats that promote LDL cholesterol formation

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