1. Mr. Smith, a 52-year old patient, is admitted to the coronary care unit with the diagnosis of acute inferior myocardial infarction. The patient has a history of smoking two packs per day of cigarettes for 35 years, and he drinks a six-pack of beer on weekend nights, but does not drink the rest of the week. He is the sole financial support for his family. He is a consultant for a company and is out of town during week days. Over the past year, Mr. Smith has gained 20 pounds. He is 5 foot 6 inches, weighing 200 pounds. His diet consists mostly of fast food. He rarely exercises. His wife cares for their three teenage children. The eldest son, 17 years of age, totaled the family car when drinking and driving 2 days ago and he is in the local children’s hospital in the intensive care unit in critical condition. Mr. Smith developed chest pain and slumped over in his chair during an argument with his wife about their teenage daughter, who is 15 years of age and wanted to get birth control pills. The wife is in the waiting room while the nurses settle Mr. Smith into his room. The youngest son, 13 years of age, is at a friend’s house. The teenage daughter is staying at the bedside of the critically ill eldest son. The wife blames her eldest son for her husband’s heart attack and told the emergency department nurse that she does not care to see her son at all. 

1. What maladaptive responses to stress may have contributed to Mr. Smith’s development of an illness?
2. Based on the case study, what family assessment data may be used to determine coping strategies being currently used by the family in crisis?
3. What nursing interventions should be used to promote effective coping for the patient and his family?

2. Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. 

1. Describe the sequence of events that caused the local inflammation seen in Mary’s foot.
2. What is the role of histamine and kinins in the inflammatory process?
3. Which of the five cardinal signs of inflammation does Mary exhibit?
4. Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects?