NR 509 Cardiovascular Lifespan Shadow Assessment

Tina’s 5-year-old cousin comes into the clinic and you notice that her heart rate increases with inspiration and decreases with expiration. What is your differential diagnosis and treatment plan for this finding?

Student Response:

My differential would include intracranial pressure and myocardial ischemia. To rule out myocardial infarction, we would need to keep an eye on her blood pressure. A CT scan could be done to rule out any bleed on the brain that could cause intracranial pressure.

If she doesn’t have any other symptoms, though, it is probably not serious.

Model Note: Differential diagnosis includes benign sinus dysrhythmia, increased intracranial pressure, increased vagal tone, and myocardial ischemia. Her blood pressure should be monitored to ensure perfusion to rule out myocardial ischemia. She should be assessed for other symptoms that may indicate an underlying problem. With no other symptoms, it can be assumed that the dysrhythmia is benign since it is so common in children.

Tina’s 68-year-old paternal aunt struggles with controlling her hypertension and high cholesterol. What concerns might you have concerning all body systems, and how would this change your assessment? What teaching points would you review with Tina’s paternal aunt?

Student Response:

Uncontrolled hypertension can put unnecessary strain on the heart causing things like heart failure and stroke.

Uncontrolled high cholesterol can make hypertension even worse and cause thrombosis and other vascular disorders. During the exam, I would need to ask questions about chest pain and pay special attention to her extremities.

Model Note: High cholesterol leads to atherosclerosis which worsens hypertension and increases the risk of cerebrovascular disease and thrombosis. High triglycerides leads to pancreatitis. Hypertension has detrimental effects on all body systems. Hypertension puts a person at risk for cardiovascular and peripheral vascular disorders, renal failure, stroke, dementia, vision loss, sleep apnea, bone loss, and sexual dysfunction.

During the assessment, special attention should be directed to visual acuity, retinal health, and perfusion to extremities. The patient should be asked about sleep disturbances, morning headaches, and daytime fatigue to rule out sleep apnea. The provider should also ask about chest pain, forgetfulness, exercise habits and sexual health. The provider needs to stress the importance of healthy eating, exercising regularly, and complying to treatment plans to avoid life-threatening consequences of hypertension.