Case Study: Heart Failure Ms. Carrie James was discharged home after a one week

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Case Study: Heart Failure Ms. Carrie James was discharged home after a one week stay in the CCU where she experienced a lethal dysrhythmia. She was successfully resuscitated, but did not return to NSR. Her rhythm, atrial fibrillation persisted despite synchronized cardioversion er discharge prescriptions included Coumadin 5 mg po daily Lasix 20 mg po daily Zocor (simvastatin) 20 mg po HS NTG SL prn for angina She was scheduled to return to Dr. one month, to reschedule. Six months later, Ms. James is h to sleep her. She calls the ambulance and ends up in the ER Chandler's office in one month, but she didn't keep the appointment or call aving increasing difficulty sleeping through the night. She has with several pillows behind her. One night she awakens extremely short of breath, which frightens as the nurse on duty in the ER, you place Ms. James in the cardiac room and begin your assessment. She is pneic, diaphoretio and appears ashen She heart rate at 122 bpm. You note that and feet. Her other vital signs are T: 08.4: BP: 134164; Resp: 28/min; C2 standing orders, you establish IV access and run a 12-lead ECG, which shows atrial is lethargic and barely answers anything you ask. You She has an irregular fields and she 's coughing up frothy sputum. edema of both legs with cardac veins are dstended and she has 02 sat 80% In The ER physician admits Ms. James with a diagnosis of acute puílmonary edema ( (uncompensated heart failure). 1. Which signs sympt rns in your assessment can be traced to upve b vendus ur dnes left-sided heart failure guru HR CICCles right-sided heart failure veins cre csterde 2. Ater a preliminary evaluation, the intern on duty writes the orders in the table below. Review the orders and complete the table. Order question this what is your rationale? order? explain Iapplicable, explain how Would you If you would question it, how this intervention this intervention would would impact preload impact afterload Position patient inrtct volmes the supine vely raagt by position bsd4 Start oxygen via face mask at 2/min Start IV with 0.9% NS

Explanation / Answer

Oxygen administration is helpful in the initial basic respiratory dysfunctions to help alleviate the saturation problem which would thus interrupt in the further interventions. Starting an IVFluid must be however considered depending on whether she has a tachycardia and taking an account of her Ejection fraction and her body weight as well. NTG drip is been prescribed as a vasodilator and prevents the hypertension thus preventing any further deterioration for aneurysms. Inj.Lasix 80mg is a perfect choice for pulmonary edema , thus helping in the removal of the body's excess fluid amounts through the urine output keeping in consideration for any hypotension which can occur . Inj .morphine sulphate 2mg for every 10min PRN must be considered because of the fact that it could cause respiratory depression as the saturation are already unstable. Insertion of a Foley catheter is very much needed to monitor the urine output and measuring them as to know the effects of Inj Lasix also must check for the urine color and if needed for a urine dipstick. ABGs (arterial blood gases ) are an important element which instantly rules out for any acid base balance corrections which could be immediately started through infusions thus preventing from potential complications. Inj Heparin infusion must be asked for its prescription as I wonder in taking account for the PT-INR level and PTT levels and in case of any internal bleeding which could be diagnosed through an echo. Inj .metoprolol 5mg can be given as a STAT dosage taking in consideration for the BP and the HEart rate and as we had already given Lasix it is wise to check these hemodynamics before its administration.

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