THE COLLEGE OF MAASIN

Nisi Dominus Frustra

College of Nursing and Allied Health Sciences

SCENARIO:
You are a nurse at a free-standing cardiac prevention and rehabilitation center. Your new
client in risk factor modification is Dominik Fernandes, a 37-year-old traveling salesman, who is
married and has 3 children. During a recent evaluation for chest pain (including a cardiac
catheterization), he was diagnosed with angina pectoris, given a prescription for SL nitroglycerin,
told how to use it, and referred to your cardiac rehabilitation program for sessions 3 days a week.
Dominik’s wife comes along to help him with healthy lifestyle changes. You take the following
nursing health history: Dominik’s father died of sudden cardiac death at age 42, and his mother
(still living) had a CABG x 4 (quadruple CABG) at age 52; his hypertension is controlled with
nifedipine (Procardia) 90 mg PO qd, which he has taken regularly; he has averaged 1 ½ cigarette
packs per day for 20 years; an “occasional” beer (“a 1 case Red Horse Beer every weekend with
the barkada”); and a dietary history of fried and fast foods at Jolibee and Andok’s. His current
weight is 107 kg at 5’8”; he has waist circumference of 48 inches. His VS are 140/90, 82, 18, 37.4C.

1. Calculate Dominik’s smoking history in terms of pack years.

2. List three non-modifiable risk factors for CAD.
3. List six modifiable risk factors for CAD.
4. You would like to know more about Dominik’s hyperlipidemia. What 4 common laboratory
values do you need to know?

Dominik, laughingly tells you he believes in 5 happy food groups: salt, sugar, fat, chocolate, and
caffeiene.

5. Of all his behaviors, which one is the most significant in promoting cardiac disease?
6. What is the most important priority problem that you need to address with Dominik? Identify
an appropriate strategy to resolve the problem.
7. What is the second problem you would work with Dominik to change?
8. Dominik’s wife – Xayrah takes you aside and tells you, “I’m so worried for Dom. I grew up in a
really dysfunctional family where there was a lot of violence. Dom has been so good to the kids
and me. I’m so worried I’ll lose him that I have nightmares about his heart stopping. I find myself
suddenly awakening at night just to see if he’s breathing.” How are you going to respond?
9. What are you going to do to obtain additional information? List 5.
10. Dominik continues to feel symptomatic. What are you going to do?

Prepared by:

JESELO OUANO GORME, RN