Coronary Artery Disease with a Primary Comorbidity of Type II Diabetes

Rob Geis is a 65-year-old Hispanic male from Cleveland, Ohio. He and his wife were visiting friends in Jacksonville as part of a multi-stop Florida vacation. Rob was brought to the emergency department of St. Vincent Medical Center’s Southside location on the evening of January 27, 2014, by ambulance after he experienced a total loss of consciousness while dining at a restaurant with his wife and a group of friends. Rob has no recollection of the event. His wife reported he stumbled as he was returning from the restroom, but did not fall and was able to make it into his chair at the table. She noticed he did not look well and he was pale. Once he was seated â€Å"his head kept dropping and then he lost consciousness for a few seconds.† His wife said he appeared very gray and sweaty. The emergency responders reported Rob had a low respiratory rate during assessment at the scene. Rob Geis reported he has never before had an episode of syncope. He denied having any heart palpitations, chest pains, or shortness of breath prior to losing consciousness. Prior to the episode he experienced no diaphoresis, fever, chills, dizziness, headache, or neck pain or stiffness. He also had no nausea, vomiting, diarrhea, abdominal pain, rectal bleeding, hematuria, dysuria, focal weakness, or sensory changes. Also, there were no witnessed indications of seizure activity. Prior to the episode Rob Geis had an active day playing golf with friends and had consumed several alcoholic beverages, but these are not unusual activities for him. Rob reported he had experienced upper back pain, which is uncommon for him, while playing golf. His upper back pain had dissipated prior to the episode of syncope. Rob also reported that approximately ... ...& K.L. McCance (Eds.), Understanding pathophysiology (5th ed., pp. 447-476). St. Louis, MO: Mosby Little, T.K. (2013). Assessment of the Cardiovascular System. In D.A. Ignatavicius & M.L. Workman (Eds.), Medical-surgical nursing: Patient centered collaborative care (7th ed., pp. 686-710). St. Louis, MO: Saunders O’Donovan, K. (2012). Management of diabetes and acute coronary syndromes. British Journal of Cardiac Nursing, 7(8), 370-375. Roger, V.L., Go, A.S., Lloyd-Jones, D.M., Benjamin, E.J., Berry, J.D., Borden, W.B., †¦ Turner, M.B. (2012). Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Retrieved from: http://circ.ahajournals.org/content/125/1/ e2.full.pdf+html Tierney, P., Hughes, C., & Hamilton, S. (2011). Promoting health behaviour change in the cardiac patient. British Journal of Cardiac Nursing, 6(3), 126-130.