

Solution Manual for Medical Terminology for Health

Professions 7th Edition Ehrlich Schroeder 1111543275

CHAPTER 5
9781111543273
Full download link at:
Solution manual: https://testbankpack.com/p/solution-manual-for-medical-terminology-
for-health-professions-7th-edition-ehrlich-schroeder-1111543275-9781111543273/
Test bank: https://testbankpack.com/p/test-bank-for-medical-terminology-for-health-
professions-7th-edition-ehrlich-schroeder-1111543275-9781111543273/

TEACHING TOOLS
FOR CHAPTER 5
THE CARDIOVASCULAR SYSTEM
The Instructor Resources teaching tools for this chapter include:
 The answer key for the Learning Exercises for the chapter, located in the file entitled Textbook Learning Exercises
Answer Key. These Learning Exercises are at the end of each chapter in Medical Terminology for Health
Professions, Seventh Edition, and in the Student Workbook for Introduction to Medical Terminology, Third Edition.
The answer key is also in the PowerPoint presentation for the chapter.
 A PowerPoint presentation for this chapter, including the Overview of this body system from the beginning of the
chapter, the Textbook Learning Exercises Answer Key, and the following animations and videos:
 Electrical Stimulation of the Heart
 Coronary Bypass Surgery
In this chapter of the Instructor’s Manual, you will find:
 Personal Response Device questions (and answers) to engage students’ interest
 Classroom Quizzes and their Answer Keys
 Two 25-question quizzes for the Standard Syllabus testing on key word parts and all primary terms
 Two 25-question quizzes for the Simplified Syllabus testing only on the 15 word parts and 60 terms in the
vocabulary list at the beginning of the chapter
 Classroom Activities to help your learners enjoy their studies. This chapter includes:
 The Living Heart, a team challenge for demonstrating blood flow
 Med Term Jeopardy to help learners practice the terms from this chapter
 Crossword Puzzle and Answer Key
 Word Search and Answer Key
 “Medical Mystery” Story and Discussion Questions emphasizing the Simplified Syllabus terms (Heart Failure)
 SOAP Note and Questions (ER: Atrial Fibrillation)
 Case Study and Discussion Questions (Case History and Physical Examination: Possible Congestive Heart Failure)
 Answer Keys for the Medical Mystery, SOAP Note, and Case Study

PERSONAL RESPONSE DEVICE QUESTIONS

AND ANSWERS
These questions are designed to engage students’ interest as a unit is introduced, not to test their knowledge. Asking
students to give their answers at the start of class will get them involved in the topic, and a delay in providing the correct

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106 Chapter 5

answers will help keep them curious. The questions can be made into PowerPoint slides or written on the board, and
answers can be tallied using a personal response device (clicker) system or a show of hands.
1. If you are a universal donor, your blood group is type O. T/F
Answer: True
2. What percentage of a person’s body weight is blood?
a. 10%
b. 7%
c. 20%
Answer: b. 7%
3. Women have on average 10% more red blood cells than men. T/F
Answer: False. Men have an average of 10% more red blood cells than women.
4. An individual blood cell takes about 60 seconds to make a complete circuit of the body. T/F
Answer: True

CLASSROOM QUIZZES
There are two quizzes for the Standard Syllabus and two for the Simplified Syllabus, each made up of 25 questions.
Quiz A consists entirely of multiple-choice questions. Quiz B has a variety of question styles. Both quizzes are of equal
difficulty.

TIPS FOR USING CLASSROOM QUIZZES

 These quizzes are brief so they can be used without consuming a lot of class time. They can be used effectively
either as a pop quiz to evaluate student preparation or as makeup work when a learner has missed a class.
 If you are concerned about learners copying each other’s answers, you can alternate Quizzes A and B in the same
class.
 You can use Quiz A as the classroom quiz and Quiz B as the makeup or retest.
 Combine the two quizzes to create a 50-question chapter test.
 The Answer Keys are located immediately after the quizzes. You may want to have learners swap papers and take
a few minutes to have them grade the quizzes in class. This is an excellent review activity, and it provides valuable
insight into learner preparedness.

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 The Cardiovascular System 107

CHAPTER 5 STANDARD SYLLABUS QUIZ A

Name ____________________________________________ Date __________________ Class _______________

MULTIPLE CHOICE
Write in the letter of the correct answer.
______ 1. Which term describes an abnormal increase in the number of red blood cells in the blood?
A. polycythemia B. thrombocytosis C. leukemia
______ 2. Which term means a group of bone marrow disorders characterized by the insufficient production of blood
cells due to dysfunction of the bone marrow?
A. hemolytic reaction B. blood dyscrasia C. myelodysplastic syndrome
______ 3. Which term describes the abnormal hardening of an artery?
A. blood dyscrasia B. arthrosclerosis C. atherosclerosis
______ 4. Which term describes the blockage of a blood vessel by a foreign object circulating in the blood?
A. embolism B. embolus C. thrombosis
______ 5. Which form of anemia is characterized by red blood cells being destroyed faster than the bone marrow can
replace them?
A. aplastic B. hemolytic C. megaloblastic
______ 6. Which type of medication is administered to lower high blood pressure?
A. antihypertensive B. antiarrhythmic C. statin
______ 7. Which term means inflammation of a vein?
A. phlebitis B. arteritis C. angiitis
______ 8. Which condition is a bacterial infection of the lining or valves of the heart?
A. bacterial pericarditis B. bacterial myocarditis C. bacterial endocarditis
______ 9. Which term means an abnormally slow heartbeat?
A. bradycardia B. fibrillation C. tachycardia
______ 10. Which medication controls irregularities of the heartbeat?
A. antiarrhythmic B. thrombolytic C. vasodilator
______ 11. Which term is also known as high blood pressure?
A. orthostatic hypotension B. hypotension C. hypertension
______ 12. Which term means rapid, irregular, and useless contractions of the ventricles?
A. ventricular tachycardia B. ventricular fibrillation C. flutter
______ 13. Which condition is a genetic disorder in which the intestines absorb too much iron?
A. hemochromatosis B. blood dyscrasia C. sickle cell anemia
______ 14. Which condition is the blockage of a coronary artery that causes tissue death of the affected myocardium?
A. angina pectoris B. congestive heart failure C. myocardial infarction
______ 15. Which are the least common type of white blood cells?
A. basophils B. eosinophils C. lymphocytes
______ 16. Which term describes the blocking of an artery by a clot?
A. infarct B. ischemia C. thrombotic occlusion
______ 17. Which term means to stop or control bleeding?
A. hemostasis B. hemoglobin C. homeostasis
______ 18. Which term describes a pounding or racing heart with or without irregularity in rhythm?
A. hemostasis B. dysrhythmia C. palpitation

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108 Chapter 5

______ 19. Which condition is also known as angiitis?

A. arteritis B. vasculitis C. phlebitis
______ 20. Which condition is also known as bacteremia?
A. blood dyscrasia B. endocarditis C. septicemia
______ 21. Which diagnostic technique records the patient’s heart rates and rhythms over a 24-hour period?
A. echocardiography B. electrocardiography C. Holter monitor
______ 22. Which term means inflammation of the tissue surrounding the heart?
A. endocarditis B. myocarditis C. pericarditis
______ 23. Which term describes a localized, balloonlike enlargement of an artery?
A. aneurysm B. embolus C. thrombus
______ 24. Which form of cardiac arrhythmia is fatal unless reversed?
A. atrial fibrillation B. atrial flutter C. ventricular fibrillation
______ 25. Which term describes a deficiency of blood flowing through an organ?
A. hypoperfusion B. perfusion C. aneurysm

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 The Cardiovascular System 109

CHAPTER 5 STANDARD SYLLABUS QUIZ B

Name ____________________________________________ Date __________________ Class _______________

FILL IN THE BLANK

Write the correct term on the line provided.
1. Abnormally swollen veins in the legs are known as ______________________ veins.
2. Severe episodes of spasmodic choking or suffocating chest pain are known as ___________________.
3. A procedure in which a catheter is passed into a vein or artery and is guided into the heart is known as cardiac
______________________ .
4. The condition in which a blood clot forms within a blood vessel is known as
a/an ______________________ .
5. An inflammation involving several arteries is known as ______________________ .
6. Inflammation of a vein is known as ______________________ .
7. A complete lack of electrical activity in the heart is known as ______________________ .
8. The abnormal narrowing of a blood vessel is known as ______________________ .
9. A benign tumor made up of newly formed blood vessels is a/an ______________________ .
10. A malignancy characterized by a progressive increase in the number of abnormal leukocytes is known as
______________________ .

MATCHING
Write the letter of the correct answer on the line provided.
Column A Column B
_____ 11. aplastic anemia A. mild or severe anemia due to reduced hemoglobin and fewer red
blood cells than normal
_____ 12. hemolytic anemia B. red blood cells are destroyed too rapidly
_____ 13. pernicious anemia C. red blood cells assume an abnormal sickle shape
_____ 14. sickle cell anemia D. inability to absorb vitamin B12 normally
_____ 15. thalassemia E. absence of all formed blood elements

TRUE/FALSE
Write T for true or F for false.
_____ 16. Raynaud’s disease consists of intermittent attacks of paleness, blue color, and redness of the fingers and
toes.
_____ 17. Systolic pressure is the lowest pressure against the walls of the blood vessels.
_____ 18. High-density lipoprotein cholesterol (HDL) is also known as good cholesterol.
_____ 19. Thrombocytes are also known as platelets.
_____ 20. Blood gases include oxygen, carbon dioxide, and nitrogen.

MULTIPLE CHOICE
Write in the letter of the correct answer.
_____ 21. Which term is the name of the inner layer of the heart?
A. endocardium B. epicardium C. pericardium
_____ 22. Which of these medications is a clot-dissolving drug?
A. ACE-inhibitor B. calcium channel blocker C. tissue plasminogen activator
_____ 23. Which term means elevated plasma concentrations of cholesterol?
A. hypolipemia B. hyperlipidemia C. lipedema
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110 Chapter 5

_____ 24. Which condition is also known as iron overload disease?

A. Cooley’s disease B. hemochromatosis C. thalassemia
_____ 25. Which term describes any blood disorder in which there is an abnormally small number
of platelets?
A. thrombocytopenia B. leukopenia C. polycythemia

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 The Cardiovascular System 111

CHAPTER 5 SIMPLIFIED SYLLABUS QUIZ A

Name ____________________________________________ Date __________________ Class _______________

MULTIPLE CHOICE
Write in the letter of the correct answer.
______ 1. Which term describes the surgical removal of plaque buildup from the interior of an artery?
A. arterectomy B. atherectomy C. endarterectomy
______ 2. Which combining form means heart?
A. cardi/o B. coron/o C. ather/o
______ 3. Which combining form means blood or lymph vessels?
A. ven/o B. aort/o C. angi/o
______ 4. Which term describes the blockage of a blood vessel by a foreign object circulating in the blood?
A. embolism B. embolus C. thrombosis
______ 5. Which form of anemia is characterized by red blood cells being destroyed faster than the bone marrow can
replace them?
A. aplastic B. hemolytic C. megaloblastic
______ 6. Which term describes a group of cardiac disabilities resulting from insufficient supply of oxygenated
blood?
A. ischemic heart disease B. angina C. myocardial infarction
______ 7. Which term describes an abnormally rapid heartbeat?
A. bradycardia B. tachycardia C. atrial fibrillation
______ 8. Which condition is an inflammation of the inner lining of the heart?
A. pericarditis B. myocarditis C. endocarditis
______ 9. Which term means an abnormally slow heartbeat?
A. bradycardia B. fibrillation C. tachycardia
______ 10. Which type of medication is works by blocking the action of an enzyme that contracts blood vessels?
A. beta-blocker B. ACE inhibitor C. antiarrhythmic
______ 11. Which condition is characterized by insufficient production of one or more types of blood cells due to
dysfunction of the bone marrow?
A. myelodysplastic syndrome B. leukemia C. cardiomyopathy
______ 12. Which term means rapid, random, and ineffective contractions of the heart wall?
A. arrhythmia B. atrial fibrillation C. flutter
______ 13. Which term means the surgical removal of the lining of the portion of a clogged carotid artery?
A. carotid endarterectomy B. cardiac catheterization C. defibrillation
______ 14. Which condition is the blockage of a coronary artery that causes tissue death of the affected myocardium?
A. angina pectoris B. congestive heart failure C. myocardial infarction
______ 15. Which term describes the membrane that encloses the heart?
A. endocardium B. cardiac apex C. pericardium
______ 16. Which term describes the blocking of an artery by a clot?
A. infarct B. ischemia C. thrombotic occlusion
______ 17. Which term means to control bleeding?
A. hemostasis B. hemoglobin C. homeostasis
______ 18. Which type of anemia is an autoimmune disorder due to an inability to absorb vitamin B 12?
A. aplastic B. pernicious C. sickle cell
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112 Chapter 5

______ 19. Which term describes any situation in which the total number of leukocytes in the circulating blood is less
than normal?
A. leukemia B. leukopenia C. thrombocytosis
______ 20. Which condition is also known as bacteremia?
A. blood dyscrasia B. endocarditis C. septicemia
______ 21. Which diagnostic technique introduces a contrast medium to determine how well the heart is working?
A. echocardiography B. electrocardiography C. cardiac catheterization
______ 22. Which term describes low blood pressure that occurs in a standing posture?
A. secondary hypotension B. orthostatic hypotension C. orthostatic hypertension
______ 23. Which term describes a localized, balloonlike enlargement of an artery?
A. aneurysm B. embolus C. thrombus
______ 24. Which form of cardiac arrhythmia is fatal unless reversed?
A. atrial fibrillation B. atrial flutter C. ventricular fibrillation
______ 25. Which term describes a very rapid heartbeat that begins with the ventricles?
A. ventricular fibrillation B. ventricular tachycardia C. myocardial infarction

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 The Cardiovascular System 113

CHAPTER 5 SIMPLIFIED SYLLABUS QUIZ B

Name ____________________________________________ Date __________________ Class _______________

FILL IN THE BLANK

Write the correct term on the line provided.
1. Abnormally swollen veins in the legs are known as ______________________ veins.
2. Severe episodes of spasmodic choking or suffocating chest pain are known as ______________________.
3. A sudden blockage of a blood vessel by a foreign object, such as a blood clot, quantity of gas, or a bit of
tissue, is known as a/an ______________________ .
4. The condition in which a blood clot forms within a blood vessel is known as a/an ______________________ .
5. The term used to describe all diseases of the heart muscles is ______________________ .
6. Inflammation of a vein is known as ______________________ .
7. The systemic condition known as ______________________ is often associated with severe infections caused
by the presence of bacteria in the blood.
8. The iron-containing pigment of the erythrocytes that transports oxygen from the lungs to all of the body
tissues is ______________________ .
9. Inflammation of the heart valve is known as ______________________ .
10. A malignancy characterized by a progressive increase in the number of abnormal leukocytes is known as
______________________ .

MATCHING
Write the letter of the correct answer on the line provided.
Column A Column B
_____ 11. aplastic anemia A. red blood cells are larger than normal
_____ 12. hemolytic anemia B. red blood cells are destroyed too rapidly
_____ 13. pernicious anemia C. red blood cells assume an abnormal sickle shape
_____ 14. sickle cell anemia D. inability to absorb vitamin B12 normally
_____ 15. megaloblastic anemia E. absence of all formed blood elements

TRUE/FALSE
Write T for true or F for false.
_____ 16. Raynaud’s disease consists of intermittent attacks of paleness, blue color, and redness of the fingers and
toes.
_____ 17. Chronic venous insufficiency primarily affects the arms and hands and causes discoloration of the skin.
_____ 18. An arrhythmia is an abnormality or the loss of the normal rhythm of the heartbeat.
_____ 19. Pathologic conditions of a cellular element of the blood are known as a blood dyscrasia.
_____ 20. A transfusion reaction occurs because the patient’s blood and the donated blood do not match.

MULTIPLE CHOICE
Write in the letter of the correct answer.
_____ 21. Which term describes any blood disorder in which there are not enough platelets?
A. thrombocytopenia B. leukopenia C. polycythemia
_____ 22. Which of the following terms is also known as red blood cells?
A. hemoglobin B. leukocytes C. erythrocytes

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114 Chapter 5

_____ 23. Which antihypertensive stimulates the kidneys to increase the secretion of urine?
A. beta-blocker B. ACE inhibitor C. diuretic
_____ 24. Which of the following is a procedure in which a small balloon on the end of a catheter is used to open a
partially blocked coronary artery?
A. angioplasty B. atherectomy C. vasodilator
_____ 25. Which diagnostic procedure monitors the flow of blood though the heart during activity?
A. electrocardiogram B. thallium stress test C. duplex ultrasound

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 The Cardiovascular System 115

CHAPTER 5 STANDARD SYLLABUS QUIZ

ANSWER KEYS

QUIZ A ANSWER KEY

1. A 6. A 11. C 16. C 21. C
2. C 7. A 12. B 17. A 22. C
3. C 8. C 13. A 18. C 23. A
4. A 9. A 14. C 19. B 24. C
5. B 10. A 15. A 20. C 25. A

QUIZ B ANSWER KEY

1. varicose 6. phlebitis 11. E 16. T 21. A
2. angina 7. asystole 12. B 17. F 22. C
3. catheterization 8. angiostenosis 13. D 18. T 23. B
4. thrombosis 9. hemangioma 14. C 19. T 24. B
5. polyarteritis 10. leukemia 15. A 20. T 25. A

CHAPTER 5 SIMPLIFIED SYLLABUS QUIZ ANSWER KEYS

QUIZ A ANSWER KEY

1. B 6. A 11. A 16. C 21. C
2. A 7. B 12. B 17. A 22. B
3. C 8. C 13. A 18. B 23. A
4. A 9. A 14. C 19. B 24. C
5. B 10. B 15. C 20. C 25. B

QUIZ B ANSWER KEY

1. varicose 6. phlebitis 11. E 16. T 21. A
2. angina 7. septicemia 12. B 17. F 22. C
3. embolism 8. hemoglobin 13. D 18. T 23. C
4. thrombosis 9. valvulitis 14. C 19. T 24. A
5. cardiomyopathy 10. leukemia 15. A 20. T 25. B

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116 Chapter 5

CLASSROOM ACTIVITIES FOR CHAPTER 5

The activities for each chapter are different; however, many of these activities can also be adapted for other chapters.

THE LIVING HEART

Help students understand the flow of blood to and from the heart through this group activity. Divide students into two
or more teams. Give each team a ball of red yarn and a ball of blue yarn. Ask each team to come up with a brief classroom
presentation, using the yarn to demonstrate how oxygen-rich blood (red) and oxygen-poor blood (blue) circulate through
the body, and how and when oxygenation takes place.

MED TERM JEOPARDY

This very popular team activity is a medical terminology version of the television quiz show Jeopardy!

ADVANCE PREPARATION

 The grid. Make an overhead transparency of the game grid (see Figure 5.1 at the end of this chapter’s Teaching
Tools). During play, cross off categories and grid squares as they are used. At the end of a game, wipe the grid clean
to ready it for reuse. (If an overhead projector is not available, draw the grid on the board.)
 The questions. Prepare a list of questions so there is one question for each square on the grid. A sample list is shown
in Figure 5.2, which can be found at the end of this chapter’s Teaching Tools.
 Show host. The host, usually the teacher, asks the questions and marks off the categories as they are used.
 Contestants. The game can be played with three or four contestants who stand or are seated at the front of the room
facing the audience, or with the entire class divided into two teams. For team play, decide whether learners will take
turns answering alone or whether other team members may give clues or suggestions.
 Scorekeeper. One learner is appointed as the scorekeeper. Scores are recorded on the board.
 Judges. Two learners act as judges to decide whether the response is correct.
 Audience. If playing with only three or four contestants, all other learners are the audience. They should be
encouraged to participate actively by applauding and trying to guess the right answers to help create more
excitement.

PLAYING MED TERM JEOPARDY

 The first contestant is selected randomly and is allowed to choose the first category and value.
 The host gives the “answer.” The contestant responds with the appropriate “question.” This format must be correct
or the response is considered to be wrong.
 If the response is correct, points are added to that contestant’s score.
 If the response is not correct, points are subtracted from the contestant’s score. Then the other contestants have an
opportunity to answer the question correctly and win the points.
 Whoever answers correctly gets to select the next category and question value.
 If no one can answer a question correctly, the host reads the correct answer and the contestant who originally chose
that question chooses a new one.
 The round ends when all questions in all categories have been used.

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 The Cardiovascular System 117

CHAPTER 5 CROSSWORD PUZZLE

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118 Chapter 5

CHAPTER 5 CROSSWORD PUZZLE ANSWER KEY

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 The Cardiovascular System 119

CHAPTER 5 WORD SEARCH PUZZLE

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120 Chapter 5

CHAPTER 5 WORD SEARCH PUZZLE ANSWER KEY

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 The Cardiovascular System 121

MEDICAL MYSTERY FOR CHAPTER 5

CRANTON CARDIOLOGY SERVICES

Name: Teresa W.
Age: 38
Height: 5 5
Weight: 185 pounds
Symptoms: edema in the feet, coughing,
breathlessness, and fatigue

HER STORY
With three kids and a full-time job, Teresa was accustomed to feeling tired. Lately, however, she was truly exhausted
because she was having trouble breathing, which kept her up at night. Teresa soon developed a cough as well, but she
wasn’t overly concerned; she blamed her symptoms on her busy schedule, being overweight, and her lifelong battle with
allergies.
Finally, after a few months of severe fatigue, breathlessness, and a persistent cough, Teresa consulted her primary care
physician. She ordered blood tests to rule out thyroid problems and diabetes, but she was most concerned with Teresa’s
blood pressure: it was 160/120 mm Hg. Her doctor became extremely worried and asked me to see Teresa in our
cardiology practice later that same day.

THE EVALUATION
I found out from Teresa’s medical history that her father had died of myocardial infarction when he was 63 and her
mother had hypertension for years. During our talk, I could hear that Teresa had dyspnea. On auscultation, I detected
abnormal lung sounds. Her feet and ankles clearly had edema, and her blood pressure was much higher than when her
physician had checked it just hours earlier.
Meanwhile, with a rush on the blood tests that Teresa’s primary care physician had ordered, we were able to rule out
diabetes. Although the thyroid test results weren’t available yet, it seemed unlikely that a thyroid disorder was to blame
for Teresa’s problems. She did not have other symptoms that characterize hypothyroidism, such as inexplicable weight
gain, thinning hair, and constipation.
I began to suspect that Teresa had a serious heart problem, so I ordered an electrocardiogram (EKG) and an
echocardiogram. These tests revealed that Teresa had tachycardia and cardiomegaly—sure signs that her heart had been
damaged.

THE DIAGNOSIS
The EKG and the echocardiogram results confirmed my suspicion that Teresa was suffering from congestive heart
failure, a life-threatening condition in which the heart is unable to pump enough blood throughout body. Heart failure
patients tend to get easily fatigued because there is not enough oxygen circulating throughout the body; these circulation
problems cause edema, too. More specifically, Teresa appeared to have pulmonary edema, which leads to the difficulties
in breathing.
While many conditions can lead to heart failure, high blood pressure was the clear culprit in Teresa’s case. Hypertension
puts too much pressure on the blood vessels, which forces the heart to pump harder. Without treatment, Teresa’s heart
would continue to enlarge and weaken, which could be fatal.

THE TREATMENT
Because Teresa’s symptoms were so severe, I called an ambulance to take her to the hospital right away. In the hospital,
she was given diuretics to remove excess body fluid, including from her lungs. I also prescribed ramipril, an ACE
inhibitor that would lower Teresa’s blood pressure and reduce the exertion on her heart.
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122 Chapter 5

Heart failure is a chronic condition that can’t be cured and must be managed with strategies to improve heart function.
Once her condition was stabilized, I added carvedilol, a combination alpha and beta blocker that controls blood pressure
and slows heart rate, to her medications. In some people, it improves heart function as well.
I also advised Teresa to lose weight and reduce her salt intake since too much sodium would cause fluid to build up in
her lungs and extremities. I asked her to undergo a stress test and then to sign up for a medically supervised exercise
program at the local hospital.

CASE CLOSED
When Teresa came back to see me 3 months later, the swelling in her feet had gone down considerably. Her blood
pressure was under control, and her fatigue had let up considerably. In addition to her supervised workout, Teresa had
started taking a daily walk and returned to work part time. Heart failure can’t be cured, and Teresa is still likely to have
a shorter lifespan than someone without it, but taking her medications and following a healthy lifestyle will help her stay
well for as long as possible.

Discussion Questions
1. Teresa’s blood pressure was 160/120 mm Hg. What do each of these numbers measure?
2. What are tachycardia and cardiomegaly? Give the word parts for these terms.
3. Differentiate between an electrocardiogram and an echocardiogram (see Chapter 15).
4. How do ACE inhibitors work to lower blood pressure?

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 The Cardiovascular System 123

SOAP NOTE CHAPTER 5

Seven Nations Hospital ER Shift Change Report 5/14/12 Bed 8 Patient: Julia Two-Feathers

SUBJECTIVE
 Sudden onset of weakness, palpitations, dizziness, and nausea

OBJECTIVE
 62-year-old female
 Pale, diaphoretic (sweaty)
 Vital signs: hypotension - blood pressure 87/42, heart rate irregular & tachycardic, in the 150s
 Cardiac monitor shows atrial fibrillation

ASSESSMENT
 Unstable atrial fibrillation (considered unstable because the patient’s vital signs are not within
normal limits)

PLAN
 Give beta-blockers and IV fluids
 Consider antiarrhythmic and vasoconstrictor
 Prepare patient for defibrillation
 Give information on artificial pacemaker

Questions
1. Define tachycardia and provide the word parts.
2. The doctor has prescribed beta-blockers. What will that do for Julia Two-Feather’s symptoms?
3. What is defibrillation?

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124 Chapter 5

CASE STUDY FOR CHAPTER 5

HISTORY AND PHYSICAL EXAMINATION

Patient Name: Nancy Macron Date: 8/8/08

Ref. Phys.: Lee Wong, M.D.
HPI: Nancy Macron is a 53-year-old postmenopausal female who states she was doing well until about 1 month ago,
when she developed dyspnea on exertion as well as nocturnal dyspnea and orthopnea [breathing discomfort occurring
or made worse by lying flat]. She also complained of peripheral edema in her lower extremities over that period of time.
The patient gives a history of atypical chest discomfort located over the left breast, described as a dull ache unrelated to
exertion and not relieved by rest. She denies any radiation of the pain and would rate the pain 5 out of 10. She denies the
feeling of pressure or tightness, or of a ripping sensation in the chest. The pain is not worsened or improved with
inspiration. She denies a prior history of coronary artery disease or prior history of myocardial infarction.
Her risk factors are negative for hypertension or diabetes mellitus. She does admit to tobacco use, with a 45 pack-year
smoking history.
Family History: Her family history is negative for coronary artery disease.
Allergies: NKDA.
Medications: digoxin 0.125 mg daily, KCl-Extended Release 8 mEq t.i.d. [“ter in die,” Latin for three times a day],
furosemide (Lasix) 40 mg b.i.d. [“bis in die” Latin for twice a day.]
Past Medical History: HTN [hypertension], colon cancer, cholecystitis.
Operative History: She gives a history of cholecystectomy 5 years ago. Carcinoma of the colon was discovered and
treated 10 years ago.

PHYSICAL EXAMINATION
Vital Signs: Blood pressure was 130/80, pulse was 90 and regular. Her weight is 213 pounds and height 5' 3".
General: She is a well-nourished, well-developed, obese female in no acute distress.
HEENT: Head is atraumatic, normocephalic. Eyes: pupils equal, round, and reactive to light, the sclera was clear,
the conjunctiva was pink.
Neck: Supple. There is a good carotid upstroke noted bilaterally. The thyroid was noted to be midline. No bruits
were appreciated.
Chest and Lungs: Clear to A & P [auscultation and percussion] without rales, rhonchi, or wheezes appreciated.
Cardiac: S1 and S2 were heard, no S3 [first through third heart sounds]. No murmurs were appreciated.
Abdomen: Positive bowel sounds, no distention, no tenderness. I was unable to palpate the liver or spleen.
Extremities: Negative for cyanosis, clubbing, or edema bilaterally.
Impression/Plan: The history is compatible with congestive heart failure. However, at this time, the patient is not in
congestive heart failure. This most likely is secondary to the fact that she is on digoxin, furosemide (Lasix), and extended-
release KCl. Randomized controlled trials indicate that administration of a beta-blocker, specifically carvedilol, has
proven mortality benefit for patients with CHF, and therefore the patient will be started on a 3.25 mg b.i.d. dose.
The patient’s smoking is her primary risk factor for heart disease along with being postmenopausal. Based on these
factors and her symptoms, diagnostic testing is merited, beginning with an echocardiogram to evaluate left ventricular
function and structure, as well as a stress test with thallium to evaluate for the presence of coronary artery disease.
Thank you very much for allowing me to see this patient. After the studies have been completed, a follow-up letter will
be forwarded.

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 The Cardiovascular System 125

L.E. Bergeron, M.D.

Discussion Questions
1. The patient has a history of cholecystectomy. What does this mean?
2. The physician plans to order an echocardiogram. Look in Chapter 15 of the textbook, and give a definition of this
test.
3. Describe a thallium stress test as you might explain it to the patient.
4. The report states that the patient does not have a history of myocardial infarction. What is this?

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126 Chapter 5

MEDICAL MYSTERY DISCUSSION QUESTIONS ANSWER KEY

1. Blood pressure is the measurement of the amount of systolic and diastolic pressure exerted against the walls of the
arteries. Systolic pressure occurs when the ventricles contract, and is the highest pressure against the walls of an
artery. Diastolic pressure occurs when the ventricles are relaxed, and is the lowest pressure against the walls of an
artery.
2. Tachycardia (tachy- means rapid, card means heart, and -ia means abnormal condition) is an abnormally rapid
resting heart rate. Cardiomegaly (cardi/o means heart, and -megaly means enlargement) is the abnormal
enlargement of the heart that is frequently associated with heart failure.
3. An electrocardiogram is a record of the electrical activity of the myocardium. Since the activity of the heart
muscles is triggered by electrical impulses, this noninvasive test would show the rate and regularity of Teresa’s
heartbeats. Echocardiography is an ultrasonic diagnostic procedure used to evaluate the structures and motion of
the heart.
4. An ACE inhibitor (angiotensin-converting enzyme) blocks the action of the enzyme that causes the blood vessels
to contract, resulting in hypertension. When this enzyme is blocked, the blood vessels are able to dilate (enlarge)
and this reduces the blood pressure.

SOAP NOTE ANSWER KEY

1. Tachycardia is an abnormally rapid resting heart rate (tachy- means rapid, card means heart, and -ia means
abnormal condition). The term tachycardia is usually applied to a heartbeat rate of greater than 100 beats per
minute.
2. A beta-blocker reduces the workload of the heart by slowing the rate of the heartbeat.
3. Defibrillation is the use of electrical shock to restore the heart’s normal rhythm. This shock is provided by a
device known as a defibrillator.

CASE STUDY DISCUSSION QUESTIONS

ANSWER KEY
1. A cholecystectomy means she’s had her gallbladder surgically removed.
2. Echocardiography is an ultrasonic diagnostic procedure used to evaluate the structures and motion of the heart.
The resulting record is an echocardiogram.
3. A stress test lets your doctor see how well your heart is pumping blood before and after activity that causes an
increase in your heart rate. A small amount of radioactive substance (thallium) is injected to allow the doctors to
get a picture of how well the heart is able to function, based on how open the arteries are that provide nutrients to
the heart.
4. A myocardial infarction, also known as a heart attack, is the occlusion of one or more coronary arteries caused
by plaque buildup.

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 The Cardiovascular System 127

FIGURE 5.1 Cardiovascular System Jeopardy Game Grid

Word Parts Anatomy Pathology Procedures Hodge Podge

100 100 100 100 100

200 200 200 200 200

300 300 300 300 300

400 400 400 400 400

500 500 500 500 500

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128 Chapter 5

FIGURE 5.2 Cardiovascular System Jeopardy Questions

Word Parts Host Contestant

100 CARDI/O What combining form means heart?

200 ARTERI/O What combining form means artery?

300 LEUK/O What combining form means white?

400 -CRASIA What suffix means a mixture or blending?

500 PHLEB/O What combining form means vein?

Anatomy

100 aorta What is the largest of the arteries?

200 erythrocytes What term means red blood cells?

300 endocardium What term means the lining of the heart?

400 venae cavae What large veins return blood to the heart?

500 atria What are the upper chambers of the heart?

Pathology

100 cardiomegaly What term means abnormal enlargement of the heart?

200 aneurysm What term means a balloonlike enlargement of an artery?

300 myocardial infarction What term is also known as a heart attack?

400 phlebitis What term means inflammation of a vein?

500 embolus What is a foreign object circulating in the blood?

Procedures

100 angiography What procedure is a radiographic study of blood vessels?

200 valvuloplasty What procedure is the surgical repair of a heart valve?

300 coronary artery bypass graft What procedure involves implanting a piece of vein on the heart?
400 defibrillation What procedure uses electrical shock to restore the heart’s normal
rhythm?

500 electrocardiography What test measures electrical activity of the myocardium?

Hodge Podge

100 angiostenosis What term means abnormal narrowing of a blood vessel?

200 palpitation What term means a pounding, racing heart?

300 cholesterol What fatty substance builds up on the walls of arteries?
400 hemostasis What term means to control bleeding?

500 balloon angioplasty What procedure opens a partially blocked artery?

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