I like someone to provide details to the following questions. 1. Based on the physical assessment findings, what areas a
Posted: Tue May 17, 2022 10:11 pm
I like someone to provide details to the following
questions.
1. Based on the physical assessment findings, what areas
are of major concern and warrant continued assessment?
Why?
2. The abnormal cardiac findings are listed below. How would you
explain these findings?
A. Displaced PMI
B. S 3
C. Jugular vein distention
D. Pitting edema lower extremities
E. Fatigue
3. What are nursing interventions and actions to support the
client?
Case Study #4 Cardiac Compromise As the on-coming nurse on a telemetry cardiovascular unit, you receive report about GC, who was admitted with a diagnosis of heart failure 48 hours ago. He is a 56-year-old male who presented to his primary care provider with a 2-month history of worsening symptoms of dyspnea on exertion, a nonproductive cough, general fatigue, and decreased activity tolerance. Initially, the patient thought he had the flu; however, when the symptoms persisted, longer than expected, he sought medical attention. At the office, GC was found to have profound jugular venous distention, rhonchi in both lungs, and lower extremity swelling. After admission, he had an echocardiogram, and his serum BNP was found to be 1,560 pg/mL. Coronary angiography, which was performed to provide a definitive diagnosis, revealed no evidence of coronary artery disease. Echocardiogram reveals moderate concentric hypertrophy of the ventricles, moderate left ventricular dysfunction, ejection fraction 33%, and mild to moderate mitral regurgitation. Angiogram: normal coronary arteries, ejection fraction 33%, confirmed reduction in ventricular function with a ventriculogram. Past Medical History Hyperlipidemia diagnosed 3 years ago; hypertension diagnosed this past year. GC has had a history of obesity for over 20 years, and a history of hypothyroidism diagnosed 12 years ago. Physical Exam Vital Signs: HR: 84 bpm; BP: 146/84 mm Hg; Temp: 36.8 C; O2 sat: 94% on 2 L NC; pt denies pain General appearance: Well-nourished male with appropriate affect and no apparent distress. Extremities: 2+ pulses, skin warm, cap refill less than 3 seconds 3+ pitting edema noted in lower ankles bilat extending to mid-calf. Pulmonary: Bibasilar crackles without wheezing or retractions; nonproductive cough. Cardiac: S1 and S2 present; S3 present at PMI. PMI displaced laterally into the anterior axillary line of his chest. Abd: Bowel sounds active X 4 quads; liver span percusses at 7 cm right midclavicular line; abd nontender, soft, nondistended.
ABC Hospital Inpatient Orders General Date: Today Time: 0800 Admit to: 5W SERVICE: Cardiology Full Code Diagnosis Acute heart failure Condition Good OFair Guarded Allergies NKDA Allergy Vital Signs Admitting Medical Orders Vital signs and O2 saturation every 4 hours Call MD if SBP > _140_mmHg or SBP < _100_mmHg; HR >_120_ or HR < _60_, RR>_30__or RR _12_;T>_38_, 02 sat < 92%, glucose <70>150 mg/dl Activity Diet Bed rest Bed rest with commode privileges Dout of bed to chair with assistance (BID), bathroom privileges Ambulate in hall with assistance and oxygen four times daily Physical therapy consultation Cardiac rehabilitation consultation ONPO (except for meds) calorie-restricted diet, no caffeine CADIACS Diet (4 gram Na, low cholesterol), no caffeine Heart Failure Diet (2 gram Na), no caffeine, fluid restriction (less than 2 L/day) 1,800 calorie diabetic diet IV Fluids 1/0 and Weight Monitoring HEPLOCK with 3 mL normal saline flush Q12 hours (document on flow sheet 0800H and 2000H) D NS with mEq KCLIL @__mL/hour Strict recording of Ins and Outs with running totals of urine output to be recorded Daily AM weights; record in chart Pulse oximetry: continuous Q 4 hours Telemetry continuous OGlucometer before each meal 022 L/min nasal cannula to maintain IS every 4 hours when awake Simvastation 20 mg PO at bedtime Levothyroxine 0.125 mg PO daily Furosemide 80 mg IV BID Potassium 40 mEq PO BID Lisinopril 2.5 mg PO daily Oxygen Medications PRN Medications Laboratory Studies Morphine Sulfate 3 - 5 mg IV every 5 minutes, max 15 mg every 3 hours prn chest pain CBC now Basic Metabolic Panel daily BNP X 3 Lipid Panel now Chest x-ray in AM Diagnostic Studies
Day 1 Evening Day 2 Morning Test CXR WBC Lymphocytes Monocytes Bands Neutrophils Hct Hgb Platelets RBCS Na K Chloride HCO3 Glucose Creatinine BUN BNP Cholesterol HDL LDL Day 1Admission Normal 8.5 mm3 20% 4% 12% 70% 40% 13.9 g/dL 200,000 UL 4.89 mm3 136 mEq/L 4.8 mEq/L 103 mEq/L 35 mEq/L 110 mg/dL 1.8 mg/dL 30 mg/dL 610 pg/ml 260 mg/dL 36 mg/dL 187 mg/dL 7.9 mm3 22% 2% 18% 70% 39% 13.5 g/dL 210,000 UL 5.02 mm3 138 mEq/L 3.5 mEq/L 104 mEq/L 35mEq/L 108 mg/dL 1.4 mg/dL 24 mg/dL 425 pg/ml 8.3 mm3 21% 4% 17% 69% 44% 14.9 g/dL 225,000 UL 4.96 mm3 137 mEq/L 3.8 mEq/L 103 mEq/L 32 MEq/L 102 mg/dL 1.2 mg/dL 18 mg/dL 400 pg/ml Triglycerides 196 mg/dL
questions.
1. Based on the physical assessment findings, what areas
are of major concern and warrant continued assessment?
Why?
2. The abnormal cardiac findings are listed below. How would you
explain these findings?
A. Displaced PMI
B. S 3
C. Jugular vein distention
D. Pitting edema lower extremities
E. Fatigue
3. What are nursing interventions and actions to support the
client?
- I Like Someone To Provide Details To The Following Questions 1 Based On The Physical Assessment Findings What Areas A 1 (334.25 KiB) Viewed 50 times
- I Like Someone To Provide Details To The Following Questions 1 Based On The Physical Assessment Findings What Areas A 2 (238.22 KiB) Viewed 50 times
- I Like Someone To Provide Details To The Following Questions 1 Based On The Physical Assessment Findings What Areas A 3 (185.13 KiB) Viewed 50 times
ABC Hospital Inpatient Orders General Date: Today Time: 0800 Admit to: 5W SERVICE: Cardiology Full Code Diagnosis Acute heart failure Condition Good OFair Guarded Allergies NKDA Allergy Vital Signs Admitting Medical Orders Vital signs and O2 saturation every 4 hours Call MD if SBP > _140_mmHg or SBP < _100_mmHg; HR >_120_ or HR < _60_, RR>_30__or RR _12_;T>_38_, 02 sat < 92%, glucose <70>150 mg/dl Activity Diet Bed rest Bed rest with commode privileges Dout of bed to chair with assistance (BID), bathroom privileges Ambulate in hall with assistance and oxygen four times daily Physical therapy consultation Cardiac rehabilitation consultation ONPO (except for meds) calorie-restricted diet, no caffeine CADIACS Diet (4 gram Na, low cholesterol), no caffeine Heart Failure Diet (2 gram Na), no caffeine, fluid restriction (less than 2 L/day) 1,800 calorie diabetic diet IV Fluids 1/0 and Weight Monitoring HEPLOCK with 3 mL normal saline flush Q12 hours (document on flow sheet 0800H and 2000H) D NS with mEq KCLIL @__mL/hour Strict recording of Ins and Outs with running totals of urine output to be recorded Daily AM weights; record in chart Pulse oximetry: continuous Q 4 hours Telemetry continuous OGlucometer before each meal 022 L/min nasal cannula to maintain IS every 4 hours when awake Simvastation 20 mg PO at bedtime Levothyroxine 0.125 mg PO daily Furosemide 80 mg IV BID Potassium 40 mEq PO BID Lisinopril 2.5 mg PO daily Oxygen Medications PRN Medications Laboratory Studies Morphine Sulfate 3 - 5 mg IV every 5 minutes, max 15 mg every 3 hours prn chest pain CBC now Basic Metabolic Panel daily BNP X 3 Lipid Panel now Chest x-ray in AM Diagnostic Studies
Day 1 Evening Day 2 Morning Test CXR WBC Lymphocytes Monocytes Bands Neutrophils Hct Hgb Platelets RBCS Na K Chloride HCO3 Glucose Creatinine BUN BNP Cholesterol HDL LDL Day 1Admission Normal 8.5 mm3 20% 4% 12% 70% 40% 13.9 g/dL 200,000 UL 4.89 mm3 136 mEq/L 4.8 mEq/L 103 mEq/L 35 mEq/L 110 mg/dL 1.8 mg/dL 30 mg/dL 610 pg/ml 260 mg/dL 36 mg/dL 187 mg/dL 7.9 mm3 22% 2% 18% 70% 39% 13.5 g/dL 210,000 UL 5.02 mm3 138 mEq/L 3.5 mEq/L 104 mEq/L 35mEq/L 108 mg/dL 1.4 mg/dL 24 mg/dL 425 pg/ml 8.3 mm3 21% 4% 17% 69% 44% 14.9 g/dL 225,000 UL 4.96 mm3 137 mEq/L 3.8 mEq/L 103 mEq/L 32 MEq/L 102 mg/dL 1.2 mg/dL 18 mg/dL 400 pg/ml Triglycerides 196 mg/dL