This document summarizes a case study about a 68-year-old man named Henry Brusca who presented to the emergency room with uncontrolled hypertension. It provides details about his medical history, family history, review of systems, physical assessment findings, psychosocial profile, and vital signs. It also includes questions for a nursing student about the case.

1. NURS 511 Assignment Discussion
NURS 511 Assignment DiscussionCase StudyHenry Brusca is a 68-year-old, married father
of 7 who was in relatively good health until 3 weeks ago. At that time, he visited the
emergency room with the complaint of “just not feeling right.” His BP on admission was
170/118, so he was admitted to the coronary care unit with the diagnosis of uncontrolled
HTN. His BP was controlled with medication, and he was discharged several days later. He is
now being seen for follow-up care and management of HTN. Because Mr. Brusca is newly
diagnosed with HTN, you will need to complete a history and thorough cardiovascular
examination.Case Study FindingsBiographical data:■ 68-year-old white male.■ Married,
father of seven grown children.■ Self-employed entrepreneur; BS degree in engineering.■
Born and raised in the United States, Italian descent, Catholic religion. ■ Blue Cross/Blue
Shield medical insurance plan.■ Referral: Follow-up by primary care physician. NURS 511
Assignment Discussion■ Source: Self, reliable.Current health status:■ No chest pain,
dyspnea, palpitations, or edema.■ Complains of fatigue, loss of energy, and occasional dizzy
spells.Past health history:■ No rheumatic fever or heart murmurs.■ No history of
injuries.■ Inguinal hernia repair.■ Left ventricular hypertrophy revealed by
electrocardiogram (ECG).ORDER A PLAGIARISM-FREE PAPER HERE■ Hospitalized 3 weeks
ago for HTN.Accredited BSN Program by AHPGS on February 15, 2018Page 1 of 4Accredited
University by the ASIC on March 27, 2017Kingdom of Saudi Arabia Ministry of Education
University of Hail College of Nursing‫ة‬ ‫ك‬ ‫ل‬ ‫م‬ ‫م‬ ‫ال‬ ‫ة‬ ‫ي‬ ‫رب‬ ‫ع‬ ‫ال‬ ‫ة‬ ‫ودي‬ ‫ع‬ ‫س‬ ‫ال‬ ‫ة‬ ‫وزار‬
‫ة‬ ‫ـ‬ ‫ع‬ ‫ـ‬ ‫ام‬ ‫ج‬‫م‬ ‫ي‬ ‫ل‬ ‫ع‬ ‫ت‬ ‫ال‬ ‫ح‬‫ـ‬
‫ا‬‫لٔي‬ ‫ة‬ ‫ي‬ ‫ل‬ ‫ك‬ ‫ريض‬ ‫م‬ ‫ت‬ ‫ال‬Master of Science in Nursing / Emergency
Advanced Health Assessment Theory (NURS 511) Final Open Book ExamSecond Semester
2019-2020 Questions Sheet■ No known food, drug, or environmental allergies.■ No other
previous medical problems.■ Immunizations up to date.■ No prescribed medications
except Vasotec 5 mg bid and weekly use of antacid for indigestion. Family history:■
Positive family history of HTN and stroke.■ Mother had HTN and died at age 78 of a
stroke.■ Paternal uncle died at age 79 of MI.Review of systems:■ General Health Survey:
Fatigue, weight gain of 60 lb over past 3 years.■ Integumentary: Feet cold, thick nails, tight
shoes.■ Head, Eyes, Ears, Nose, and Throat (HEENT): Two dizzy spells over past 6 months.
■ Eyes: Wears glasses, no visual complaints, yearly eye examination.■ Respiratory: “Short
winded” with activity.■ Gastrointestinal: Indigestion on weekly basis.■ Genitourinary:
Awakens at least once a night to go to bathroom.■ Musculoskeletal/Neurological: General
weakness, cramps in legs with walking.■ Lymphatic: No reported problems.■ Endocrine:
No reported problems. NURS 511 Assignment DiscussionPsychosocial profile:■ States that

2. he does not have time for routine checkups. “I only go to the doctor’s when I’m sick. “Typical
day consists of arising at 7 A.M., showering, having breakfast, and then going to work.
Returns home by 6 P.M., eats dinner, watches TV till 11:30 P.M., but usually falls asleep
before news is over. Usually in bed by 12 midnight.■ 24-hour recall reveals a diet high in
carbohydrates and fats and lacking in fruits and vegetables. Heavy-handed with salt shaker;
salts everything. Admits that he has gained weight over the years and is 60 lb overweight.■
No regular exercise program. States: “I’m too busy running my business.” Page 2 of
4Accredited University by the ASIC on March 27, 2017Accredited BSN Program by AHPGS
on February 15, 2018Kingdom of Saudi Arabia Ministry of Education University of Hail
College of Nursing‫ة‬ ‫ك‬ ‫ل‬ ‫م‬ ‫م‬ ‫ال‬ ‫ة‬ ‫ي‬ ‫رب‬ ‫ع‬ ‫ال‬ ‫ة‬ ‫ودي‬ ‫ع‬ ‫س‬ ‫ال‬ ‫ة‬ ‫وزار‬ ‫ة‬ ‫ـ‬ ‫ع‬ ‫ـ‬ ‫ام‬ ‫ج‬‫م‬ ‫ي‬ ‫ل‬ ‫ع‬ ‫ت‬ ‫ال‬ ‫ح‬‫ـ‬
‫ا‬‫لٔي‬
‫ة‬ ‫ي‬ ‫ل‬ ‫ك‬ ‫ريض‬ ‫م‬ ‫ت‬ ‫ال‬Master of Science in Nursing / Emergency Advanced Health Assessment
Theory (NURS 511) Final Open Book ExamSecond Semester 2019-2020 Questions Sheet■
Hobbies include reading, crossword puzzles, and antique collecting.■ Sleeps about 7 hours
a night, but usually feels he is not getting enough sleep. Lately is more andmore tired. Wife
states that he snores.■ Never smoked. Has a bottle of wine every night with dinner.■
Works at sedentary job, usually 7 days a week. No environmental hazards in workplace.■
Lives with wife of 45 years in a two-story, single home in the suburbs with ample living
space.ORDER A PLAGIARISM-FREE PAPER HERE■ Has a large, close, caring family.■
Admits that running his own business is very stressful, but feels he can handle it alone and
doesn’t need anyone to help him.General Health Survey findings:■ Well-developed, well-
groomed 68-year-old white male, appears younger than stated age. ■ Sits upright and
relaxed during interview, answers questions appropriately.■ Alert and responsive without
complaint, oriented x 4 (time, place, situation, and person). ■ Affect pleasant and
appropriate.■ Head-to-toe scan reveals positive arcus senilis, positive AV nicking and
cotton wool, extremity changes including thin, shiny skin, thick nails, and edema. NURS 511
Assignment Discussion■ Vital Signs■ Temperature, 36.6 °C.■ Pulse, 86 BPM, strong and
regular.■ Respirations, 18/min, unlabored.■ BP: 150/90 mmHg.■ Height: 180 CM.■
Weight: 124 KG.Cardiovascular assessment findings include:■ Neck Vessels■ Positive large
carotid pulsation, +3, symmetrical with smooth, sharp upstroke and rapid descent, artery
stiff, negative for thrills and bruits.Accredited BSN Program by AHPGS on February 15,
2018Page 3 of 4Accredited University by the ASIC on March 27, 2017Kingdom of Saudi
Arabia Ministry of Education University of Hail College of Nursing■ JVP at 30 degrees <3
cm, negative abdominojugular reflux.■ Precordium‫ة‬ ‫ك‬ ‫ل‬ ‫م‬ ‫م‬ ‫ال‬ ‫ة‬ ‫ي‬ ‫رب‬ ‫ع‬ ‫ال‬ ‫ة‬ ‫ودي‬ ‫ع‬ ‫س‬ ‫ال‬
‫ة‬ ‫وزار‬ ‫ة‬ ‫ـ‬ ‫ع‬ ‫ـ‬ ‫ام‬ ‫ج‬‫م‬ ‫ي‬ ‫ل‬ ‫ع‬ ‫ت‬ ‫ال‬ ‫ح‬‫ـ‬
‫ا‬‫لٔي‬ ‫ة‬ ‫ي‬ ‫ل‬ ‫ك‬ ‫ريض‬ ‫م‬ ‫ت‬ ‫ال‬Master of Science in Nursing /
Emergency Advanced Health Assessment Theory (NURS 511) Final Open Book ExamSecond
Semester 2019-2020 Questions Sheet■ Positive sustained pulsations displaced lateral to
apex, PMI 3 cm with increased amplitude.■ Slight pulsations also appreciated at LLSB and
base, but not as pronounced.■ Negative thrills; cardiac borders percussed third, fourth, and
fifth intercostal spaces to the left of the midclavicular line.■ Heart sounds appreciated with
regular rate and rhythm at apex S1 > S2 and +S4,at LLSB S1 > S2. ■ S2 negative split, at base
left S1 < 2 negative split, at base right S1 < 2 with an accentuatedS2, negative for murmurs
and rubs. NURS 511 Assignment DiscussionQuestions:1) What questions might be useful to
elicit further details surrounding the Chest pain, using one of the common acronyms in this

3. regard? (5 Marks)2) From the subjective information you have obtained from Mr. Brusca’s
history, what are his identifiable risk factors for heart disease? Which risk factors are
modifiable and which are unmodifiable? (5 Marks)3) List three priority nursing diagnosis
for Mr. Brusca’s case, and cluster subjective and objective data that support each diagnosis.
(3 Marks)4) From the previous data, discuss the main issues of health promotion and
disease prevention should the nurse discussed during health history and physical
examination? (4 Marks).5) Considering the relationship of the cardiovascular system to the
respiratory system, what respiratory problems might Mr. Brusca have as a result of his
cardiovascular disease? (3 Marks)02.Students_Answer_Sheetexam-question_221529_-
_Case_Study.Students_Answer_SheetNURS 511 Assignment Discussion