Ms. X., aged 55 years, has been complaining of severe fatigue and “indigestion.” Her son is quite concerned and decides to take her to the emergency department. On arrival she appears very anxious, an

Ms. X., aged 55 years, has been complaining of severe fatigue and “indigestion.” Her son is quite concerned and decides to take her to the emergency department. On arrival she appears very anxious, and her facial skin is cool and clammy; her blood pressure is 90/60, and the pulse is around 90, weak, and irregular. She is given oxygen, an intravenous line is opened, and leads for ECG are attached. Blood is taken for determination of serum enzymes and electrolytes. Tentative diagnosis is myocardial infarction involving the left ventricle. Her son provides information that indicates Ms. X is a long-time smoker, has a stressful job as a high school teacher, is recently separated after 20 years of marriage, and is fearful of losing the family home. She has also seemed to be more fatigued and stopped going to the gym about 18 months ago. She has begun to rely on “fast foods” like pizza and fried chicken and cooks infrequently. Her father had died of a heart attack at age 50. She had also noticed more fatigue and intermittent leg pain when walking or climbing stairs at work. Generalized atherosclerosis is suspected.

1. List the high-risk factors for atherosclerosis in this patient’s history.
2. Describe how atherosclerosis causes myocardial infarction.
3. It is suspected that the indigestion reported in the history was really angina. Explain how this pain may have occurred.
4. Explain each of the admitting signs.
5. What is “atypical” in Ms. X’s symptoms? How does this affect treatment and prognosis?
6. What information do serum enzyme and electrolyte levels provide?
7. What purpose does the ECG serve? It is determined that Ms. X. has a large infarct in the anterior left ventricle.
8. Ms. X. is showing increasing PVCs on the ECG. State the cause and describe the effect if these continue to increase in frequency.
9. On day 6 after admission Ms. X is preparing to go home with her son and they receive instructions on lifestyle modifications that are desirable if Ms. X is to avoid another MI. What measures should be included in such a discussion?
10. Discuss how stress could have played a factor in Ms. X’s MI and her future post discharge.
11. Ms. X’s condition becomes less stable and she remains in the hospital. On the seventh day following admission, she is found unconscious on the floor of her bathroom. Her pulse is weak and elevated, and her skin is moist with pallor evident. Her BP is 50 systolic. A diagnosis of cardiogenic shock is made, and resuscitation efforts are started.
12. Explain why Ms. X. has experienced cardiogenic shock at this time.
13. Describe the effects of cardiogenic shock on the organs of the body.
14. What problems will occur if decompensated shock occurs? How is compensation limited in this situation?
15. Ms. X dies shortly later. What is the cause of death in this case?

Please refer to the Grading Rubric for details on how this activity will be graded

Case Study Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Case Study Rubric – 100 PointsCriteriaExemplaryExceeds ExpectationsAdvancedMeets ExpectationsIntermediateNeeds ImprovementNoviceInadequateTotal PointsContent of Case StudyThe writer demonstrates a well-articulated understanding of the case study subject matter in a clear, complex, and informative manner. The case study content and theories are well developed and linked to the course content, assignment requirements, and practical experience. The case study includes relevant material that fulfills all objectives of the assignment.

Cites three or more references, using at least one new scholarly resource that was not provided in the course materials.

30 pointsThe writer demonstrates an understanding of the subject matter, and the components of the case study are accurately represented with evidence-based practice, ethics, theory, and/or role content. Course materials and scholarly resources are present to support required concepts. The paper includes relevant material that fulfills all objectives of the case study.

Cites two references.

26 pointsThe writer demonstrates a moderate understanding of the subject matter, as evidenced by components of the case study and use of evidence-based practice, theory, or role-development. Course content is present but missing depth and/or development.

Cites only one reference.

23 pointsAbsent application to evidence-based practice, theory, or role development.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Significant content of case study is vague, inaccurately portrayed, or missing.

No references cited.

Submits assignment late.

20 points30Analysis and Synthesis of Case Study Content and MeaningThrough critical analysis, the submitted case study provides an accurate, clear, concise, and complete summary of the scenario.

Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints.

All instruction requirements noted.

30 pointsCase study is complete, providing evidence of further synthesis of course content via scholarly resources.

Information is synthesized to help fulfill the case study requirements. The content supports at least one viewpoint.

Submission provides clarification of the assignment by correctly answering all posed questions within the instructions.

All instruction requirements noted.

26 pointsLacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. Case study content may be confusing or unclear, and the summary may be incomplete.

Most instruction requirements are noted.

23 pointsSubmission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Missing some instruction requirements.

Submits assignment late.

20 points30Application of KnowledgeThe summary of the case study provides information validated via scholarly resources that offer a multidisciplinary approach to the scenario provided.

The student’s application in practice is accurate and plausible, and additional scholarly resource(s) supporting the application are provided.

All questions posed within the assignment are answered correctly in a well-developed manner, applying knowledge with citations for validation.

All instruction requirements noted.

30 pointsA summary of the study, findings, and knowledge gained from the assignment is presented.

Student indicates how the information will be used within their professional practice.

All questions posed within the assignment are answered within the case study. The answer to one question may be vague and/or limited in development, but as a whole all answers are correct.

All instruction requirements noted.

26 pointsObjective criteria are not clearly used, allowing for a more superficial application of knowledge between the assignment and the broader course content.

One question is answered incorrectly and/or two case study answers are vague or limited in development but remain correct.

Student’s indication of how they will apply this new knowledge to their clinical practice is vague.

Most instruction requirements are noted.

23 pointsThe application of knowledge is significantly lacking.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Student’s indication of how they will apply this new knowledge to their clinical practice is not practical or feasible.

Application of knowledge is incorrect and/or student fails to explain how the information will be used within their personal practice.

Multiple questions are not answered or are answered incorrectly (e.g., two questions answered incorrectly, or three case study answers are vague or limited in development but remain correct).

Missing some instruction requirements.

Submits assignment late.

20 points30OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted.

3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors.

5 pointsCorrect and consistent APA formatting of references, and cites all references used. No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors, or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

2 points5To