Case Study III


Ms. M. M. is a 36 year old executive for a high profile accounting firm. She spends much of her time behind the desk working on her computer. Ms. M.M. states that recently her job has become more stressful and lately she has noticed her heart "skipping a beat" every now and then.

Ms. M. M. smokes cigarettes 1ppd and drinks at least 5 cups of coffee during the day. She states she is tired of being overweight and is taking an herbal diet pill. Ms M. M. states that she has not been sleeping well lately due to increased stress at her job.

Physical Assessment:

Neuro: AAOx3, follows all commands and exhibits equal strength in all extremities.
Pulmonary: Bilateral breath sounds with decreased bases. Ms. M. M. tells you she has a "smoker’s cough" in the mornings.
GI: No complaints, abdomen soft, nontender with active bowel sounds.
GU: Denies any GU problems. Exhibits clear, yellow urine.
CV: Slightly irregular heart rate. Pulses strong in all extremities, no edema, nail beds pink, and heart sounds are normal s1 and s2.

Vitals Pulse 88, BP 154/88, Respiratory rate 22, temp. 98.4 F. Height 5’4", weight 182 lb.

History Ms. M.M. has been smoking 1ppd for the past 10 years. She states she tried to quit, but just kept gaining weight. Ms M. M. began taking herbal diet pills 2 weeks ago in an attempt to lose weight. She doesn’t like to exercise because it is "embarrassing".

Medications: Ms. M.M. states that she takes an OTC herbal weight loss supplements that the sales clerk said is "just as good or better than ephedra". She states that she takes 1 tablet QID.

Diagnostic studies:

CXR: normal,

Labs:Blood chemistry and hematology are normal.

EKG rhythm strip:

Questions: (IMPORTANT! See instructions below*)

1. The rhythm on Ms. M. M.'s EKG is:
Sinus rhythm with PVCs
Sinus rhythm with PACs
Wandering atrial pacemaker
Junctional escape rhythm

2. The cause of this rhythm might be:
Caffeine
Tobacco
Herbal diet pills
Any or all of the above
3. The treatment for this rhythm is:
Cardioversion
Epinephrine
Correct the underlying cause
Lidocaine

4. The seriousness of this rhythm is:
Lethal
Very serious
Normal
Continued assessment is warranted

5. Nursing care for Ms. M. M. includes:
Counsel Ms. M. M. about the benefits of smoking cessation
Diet and exercise counseling
Stress reduction
All of the above


The basic dysrhythmia course that is recommended as background for this Cardiac Case Studies course is the RnCeus.com course:

EKG Strip Indentification and Evaluation


*IMPORTANT!

Please write down and save your answers to the above questions. The questions will be repeated on the "Exam and Evaluation", but the scenarios and strips will not be repeated.


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