Reference no: EM132470815

Mr. Jones, a 50-year-old professor, is 5 hours post laparoscopic cholecystectomy.

He is alert and oriented. His physical assessment is within normal limits, including active bowel sounds and a soft, slightly tender abdomen. He is sipping on clear liquids and conversant.

The nurse is performing the final assessment and providing discharge patient education. Mr. Jones states he feels a little tired because of all the excitement about going home and feeling so good after surgery.

While checking his vital signs for the discharge form, you notice that his pulse is 110 beats/min and irregular compared to the 86-90 beats/min regular pulse that he had been having since surgery. Mr. Jones states his higher pulse just reflects his excitement; he feels great, and his wife is waiting in the car at the patient discharge area for him.

What should you do?

Is there any significance in an irregular pulse? If yes, describe it.

The healthcare provider returns to the unit to assess the patient's current condition. The healthcare provider orders a stat EKG and chest X-ray, and cancels the prior written discharge order. The EKG shows atrial fibrillation with a ventricular rate of 118, with QRS and ST patterns suggesting an old anterior-wall MI.

Mr. Jones continues to rest in semi-Fowler's position in bed. His wife has returned to his bedside. Upon auscultation, you note that Mr. Jones has fine crackles in bilateral lung bases, an occasional dry nonproductive cough, and hiccups, but he denies difficulty in breathing. As you turn to leave the room, you observe Mr. Jones getting out of bed and walking toward the restroom. He is holding onto the footboard stating, "I don't know. I feel sort of weak." He appears slightly tachypneic.

Why does Mr. Jones have crackles and cough at rest and tachypnea when walking?

Which diagnostic tests would commonly be prescribed for a patient such as Mr. Jones?