Reference no: EM133568808
Situation - You are assigned Mr. Bill Burger, 65-year-old male retiree that was admitted to the hospital accompanied by his daughter. When admitted, patient was complaining of shortness of breath for 2 weeks and with worsening today prompting his visit to the ED.
Background - He has experienced orthopnea, fatigue, paroxysmal nocturnal dyspnea, and leg swelling. Mr. Burger was admitted to the hospital for the same problem last year. Mr. Burger has known heart failure for the past 3 years and was diagnosed with hypertension and hyperlipidemia 5 years ago. Before being admitted to the hospital, he was taking furosemide 40 mg, aspirin 325 mg, metoprolol 50 mg, amlodipine 10 mg, and simvastatin 40 mg for his hypertension, hyperlipidemia, and heart failure.
The patient reports no allergies to any medication, and he does not take any herbal medicines at home. His family history revealed that his father had died of ischemic heart disease 4 years ago while his brother has hypertension. As for his social history, he smokes 2-3 cigarettes a day for 35 years and the calculated smoking pack years was 5 pack years. Mr. Burger drinks socially only on the weekends.
Assessment - His current weight is 100kg and height of 74 inches tall, so his calculated body mass index (BMI) was 28.2 indicating that he is overweight. On examination, Mr. Burger is alert and conscious, but has pitting edema up to his knees. On further examination, the patient has bibasilar crackles with no rhonchi. The crackles do not clear with coughing. His vital signs are Temperature is 98.6° F (37° C), HR - 115, bpm, RR - 16, and BP 170/100 (123) mmHg, and O2 saturation of 89% on room air. A chest X-ray was conducted and revealed that he has cardiomegaly.
Lab work, including a complete blood count, liver function test, BUN, creatinine, electrolytes, BNP, and cardiac enzyme were done upon admission and significant lab values are as follows: BUN - 30, creatinine - 2.4 mg/dL, K+ - 2.8 mEq/L, and BNP 600 picograms/mL ECG was performed today and the result indicated that there was T-wave inversion and a pronounced U wave. ABG's done revealed respiratory acidosis.
Points to assess: Is this Acute or Chronic? Is the patient Unstable or Stable? Is this Urgent or Nonurgent?
What do you think are the primary alterations in health with this patient (diagnosis)?
What is the pathophysiology related to the patient's problems?
What are the risk factors for this patient, and do they contribute to the current primary problem?
What assessment(s) (expected finding) should be your focus? (Hint: Identify the relevant information first to determine what is most important.)?What signs and symptoms are commonly seen with this diagnosis?
What data should you analyze (laboratory and diagnostic procedures) and report to the health care provider? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.)
What would your plan (nursing care) and recommendation(s) be to the health care provider? (Hint: Consider all possibilities and determine their urgency and risk for this client.)?Which intervention would be best for this patient?
What intervention(s) (therapeutic procedures and/or medications) would be your priority with this patient? (Hint: Determine the desired outcome first to decide which interventions are appropriate and those that should be avoided.)
What data/clinical information would you evaluate to support the plan to improve the patient's outcome? (Hint: Think about signs that would indicate an improvement, decline, or unchanged client condition.)?What changes to the patient's condition would you expect to see happen or have happened?
What interprofessional care would be involved in the care of the patient? (Other disciplines -RT, ECG, social worker, etc.)
What patient education would be important for this patient?
Are there any specific safety considerations that should be included in your care?
What is BNP and what does it measure?
What is a normal BNP level?
What are the manifestations of right heart failure?
When would you see T-wave inversion on an ECG? What does it mean?
Could his cardiac enzymes be affected by what is going on?
What medications could be ordered other than his current medications?
What is preload?
What is afterload?
What does the following mean SV X HR = CO?
Which value would a vasodilator affect - preload or afterload?
What is the worst possible/most likely complication(s) to anticipate based on the primary problem (to prevent death)?
What nursing assessments/nursing interventions will identify this complication EARLY if it develops?