NUPP 700 Cardiac Case Study

 

All Subjects

All Subjects

Guaranteed Success

quality-guaranteed-at-professional-essay-writing-service

First Class Honors

First Class Honors

NUPP 700 Cardiac Case Study

Order 100% Plagiarism Free Essay Now

History of Present Problem:

 

 

Mary Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and systolic heart failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. She presents to the emergency department (ED) for shortness of breath (SOB) the past three days. Her shortness of breath has progressed from SOB with activity to becoming SOB at rest. The last two nights she had to sleep in her recliner chair to rest comfortably upright. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse. She has noted increased swelling in her lower legs and has gained six pounds in the last three days. She is being transferred from the ED to the cardiac step-down where you are the nurse assigned to care for her.

 

Personal/Social History:

Mary is a retired math teacher who is unable to maintain the level of activity she has been accustomed to because of the progression of her heart failure the past two years. She has struggled with depression the past two years and has been more withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction.

 

What data from the histories is RELEVANT and has clinical significance to the nurse?                                              /8

RELEVANT Data from Present Problem: Clinical Significance:
Example- The last two nights she had to sleep in her recliner chair to rest comfortably. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse.

 

1.

 

 

2.

 

 

Example: Orthopnea is a clinical RED FLAG that is commonly seen as left-sided heart failure continues to progress. The ability to speak only in partial sentences is also consistent with increased respiratory distress.

 

 

1.

 

 

2.

RELEVANT Data from Social History: Clinical Significance:
 

1.

 

 

2.

 

1.

 

 

2.

 

 

 

NUPP 700 Cardiac Case Study

Order 100% Plagiarism Free Essay Now

 

 

 

 

What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?

 

Fill in the Pharmacological classification section /Expected Outcomes                                             /9

 

PMH: Home Meds: Pharm. Classification: Expected Outcome of medication :
Diabetes Mellitus type II Hypertension

Atrial fibrillation

Hyperlipidemia

Chronic renal insufficiency (baseline Creatinine 2.0) Cerebral vascular accident (CVA) with no residual deficits

Heart Failure (systolic) secondary to ischemic cardiomyopathy

MI with stent x2 to LAD 4

years ago

  1. Example: ASA 81 mg PO daily

 

  1. Carvedilol 25 mg PO daily
  2. Lisinopril 5 mg PO daily
  3. Lipitor 10 mg PO daily
  4. Hydralazine 25 mg PO 4x daily
  5. Furosemide 20 mg PO bid
  6. KCL 20 meq PO daily
  7. Warfarin 5 mg PO daily
  8. Glyburide 5 mg PO daily
  9. Acetaminophen 650 mg PO PRN
  10. Salicylates
  1. Prevent blood clots

 

 

 

Based on the client’s home medications and past medical history as listed above, align the medication used to treat each condition                                                                                      /5

Medical Condition Medication used to treat
Diabetes Mellitus type II  
Atrial fibrillation  
Hyperlipidemia  
Chronic renal insufficiency (baseline Creatinine 2.0)  
Heart Failure (systolic) secondary to ischemic cardiomyopathy  
MI with stent x2 to LAD 4 years ago  
Diabetes Mellitus type II  
Hypertension  
Hyperlipidemia  
Cerebral vascular accident (CVA) with no residual deficits  
 


 

Patient Care Begins:

Current Vital Signs: Pain assessment P-Q-R-S-T
T: 98.6 F/37.0 C (oral) Provoking/Palliative:
P: 92 (irregular) Quality: Denies Pain
R: 26 (regular) Region/Radiation:
BP: 162/54 MAP: 90 Severity:
O2 sat: 90% (6 liters np) Timing:

What Vital Sign data is RELEVANT and must be recognized as clinically significant by the nurse?                     /4

RELEVANT Vital Signs Data: Clinical Significance:
1.

 

2.

 

3.

 

4.

 

 

 

 

 

Current Assessment:   Assessment findings
GENERAL APPEARANCE: Appears anxious, restless
RESP: Breath sounds have coarse crackles scattered throughout both lung fields ant/post, labored

respiratory effort, patient sitting upright

CARDIAC: Rhythm: atrial fibrillation, pale, cool to the touch, pulses palpable throughout, 3+ pitting edema lower extremities from knees down bilaterally, S3 gallop, irregular, no jugular venous distention (JVD) noted
NEURO: Alert and oriented to person, place, time, and situation (x4)
GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants
GU: Voiding without difficulty, urine clear/yellow
SKIN: Skin integrity intact, skin turgor elastic, no tenting present

 

 

What assessment data is RELEVANT and must be recognized as clinically significant by the nurse?               /3

RELEVANT Assessment Data: Clinical Significance:
1.

 

2.

 

3.

 

 

 

 

 

Cardiac Telemetry Strip:
Interpretation:
Atrial fibrillation
Clinical Significance:
Because of the loss of atrial kick that is present in any sinus rhythm, 30% of cardiac output can be lost

 

Radiology Reports: Chest x-ray

What diagnostic results are RELEVANT and must be recognized as clinically significant by the nurse?

/2

RELEVANT Results: Clinical Significance:
Bilateral diffuse pulmonary infiltrates consistent with

pulmonary edema

1.

 

 

 

Lab Results:

 

Complete Blood Count (CBC): Yesterday Today
WBC (4.5-11.0 mm 3) 4.8 5.8
Hgb (120-160 mmol/l) 129 132
Platelets (150-450x 103/µl) 228 202
Neutrophil % (42-72) 68 65

 

 

 

Basic Metabolic Panel (BMP): Yesterday Today
Sodium (135-145 mEq/L) 133 138
Potassium (3.5-5.0 mEq/L) 3.9 3.2
Glucose (7.0-11.0 mg/L) 11 10.8
Creatinine (60-120 mg/L) 93 93
Misc. Chemistries:
Magnesium (1.6-2.0 mEq/L) 1.9 1.8
PT/INR (0.9-1.1 nmol/L) 2.5 2.4

 

Cardiac Labs: Yesterday: Today
Troponin (<0.05 ng/mL) 0.10 0.12
BNP (B-natriuretic Peptide) (<100

ng/L)

1555 1855
Arterial Blood Gas: Current:  
pH (7.35–7.45) 7.46
pCO2 (35–45) 30
pO2 (80–-100) 72
HCO3 (18–26) 22
O2 sat (>92%) 91%
 

ABG Interpretation:

 

/1

 

What lab results are RELEVANT and must be recognized as clinically significant by the nurse?          /4

RELEVANT

Lab(s):

Clinical Significance: TREND: Identify if the results are Improved/Worsening/Stable:
1.

 

2.

 

3.

 

4.

 

 

 

 

Clinical Reasoning Begins… (This section must be accompanied by scholarly references)       /20

  1. What is the primary cardiac problem that your patient is most likely presenting with?

 

 

 

 

  1. What is the underlying cause/pathophysiology of this primary problem?

 

  1. What are the compensation mechanisms that occur in the identified primary problem and why or how can they worsen the primary problem?

1.

 

2.

 

 

 


Collaborative Care: Medical Management

Review the orders and describe the rationale for the order and the expected outcome from this treatment/ intervention                                                                                                                              /6

Orders: Rationale: Expected Outcome:
Titrate oxygen to keep O2 sat >92%

 

Furosemide 40 mg IV push

 

 

Nitroglycerin IV drip: titrate to keep SBP <130

 

 

Strict I&O

 

 

Fluid restriction of 1500 mL PO daily

 

 

Low sodium diet max 2g/day

 

 

 

  1. What body system(s) will you most thoroughly assess based on the primary problem and why? /4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All orders have all been implemented and 4 hours have passed.

Evaluation:

Evaluate the response of your patient to nursing and medical interventions during your shift. All orders have been implemented that are listed under medical management.

 

 

Current Vital Signs: Most Recent: Current PQRST:
T: 98.4 F/36.9 C (oral) T: 98.6 F/37 C (oral) Provoking/Palliative:
P: 88 (irregular) P: 82 (irregular) Quality: Denies pain
R: 24 (regular) R: 26 (regular) Region/Radiation:
BP: 112/50 MAP: 71 BP: 162/54 MAP: 90 Severity:
O2 sat: 91% (12 liters

high flow n/c)

O2 sat: 90% (6 liters n/c) Timing:

 

Current Assessment:
GENERAL

APPEARANCE:

Not as anxious, but appears restless at times
RESP: Coarse crackles scattered throughout both lung fields, labored respiratory effort
CARDIAC: Rhythm: atrial fibrillation, pale, limbs are cool to the touch, pulses palpable throughout, 3+ pitting edema in lower extremities
NEURO: Alert and oriented to person, place, time, and situation (x4)
GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all 4 quadrants
GU: 30 mL of urine out in the last 4 hours after furosemide IV given, 50 mL residual urine in bladder as assessed with bladder scan
SKIN: Skin integrity intact

 

What clinical data is RELEVANT that must be recognized as clinically significant?                                       /6

 

RELEVANT Vital Signs Data: Clinical Significance:
1.

 

2.

 

3.

 

 

 

 

1.

 

2.

 

3.

 

 

RELEVANT assessment data

1.

 

 

2.

 

 

  • Clinical Significance:

     

     

    Current State

     

    The client is now in acute-on-chronic renal failure and unable to adequately diurese. This state compromises her respiratory status. She is in need of care beyond the abilities of her current inpatient location and will be transferred to ICU for other interventions, including furosemide IV drip, continuous renal replacement therapy (CRRT), or even hemodialysis.

     

     

    Final Activity: Hand-over report to ICU

    Your knowledge and application of the pathophysiology of heart failure and renal failure have allowed you to make a series of needed assessments and judgments that have facilitated the treatment and care of your patient. You recognize that an SBAR is needed to update the primary care provider with your concerns.

     

    NUPP 700 Cardiac Case Study

    Order 100% Plagiarism Free Essay Now

    Use the SBAR template below to determine the priorities to communicate to the ICU primary care provider


    SBAR: Nurse-to-Primary Care Provider                                                       /4

     

    Situation:
    Name/age:

     

    BRIEF summary of primary problem:

     

     

    Day of admission/post-op #:

    Background:
    Primary problem/diagnosis:

     

     

    RELEVANT past medical history:

    Assessment:
    Most recent vital signs:

     

     

    RELEVANT body system nursing assessment data:

     

     

    RELEVANT lab values:

     

     

    INTERPRETATION of

    current clinical status (stable/ unstable/worsening):

    Recommendation:
    Suggestions to advance plan of care:

     

     

    NUPP 700 Cardiac Case Study

    Order 100% Plagiarism Free Essay Now

     

    Why Choose US

    quality-guaranteed-at-professional-essay-writing-service

    Order Now

    professional-essay-writing-services-take-action-button

    Discounted Rates

    essay-writing-discounted-services

    Secure Gateway

    pay-with-paypal-the-most-secured-payment-gateway