Jane B. Reath is a 67 year old female with a history of congestive heart failure
ID: 3480030 • Letter: J
Question
Jane B. Reath is a 67 year old female with a history of congestive heart failure. Mrs. Reath is an ex-smoker and only recently has decided to commit to a healthier lifestyle. Since her decision, she is conscientious about her diet and exercise and her ultimate goal is to discontinue taking her cardiac medications which include Digoxin and Lasix; she believes that if she can maintain this healthy lifestyle her body will no longer require therapeutic intervention. Recently though, Mrs. Reath has been noticing an increase in shortness of breath when engaging in simple tasks and also has noticed some "heart skipping." Because of this, she decides to visit her doctor.
Assume you are Mrs. Reath’s doctor. Here are your physical assessments and findings:
Her chest X-ray shows pleural effusion in the right lower lobe. Her labs reveal normal Na+, K+ and BUN, and Creatinine levels.
She is alert and oriented, exhibiting crackles in the lungs bilaterally. Bowel movement is normal and her urine is clear and unremarkable. She exhibits a normal heart rate and temperature, but has a blood pressure of 156/94 and her weight has increased 15lbs since her last visit one month ago.
Mrs. Reath's ECG rhythm strip can be seen in the link below:
http://i64.tinypic.com/2iiiihc.jpg
a) Identify what dysrythmia Mrs. Reath has from the ECG strip. Explain your reasoning.
b) What might be an appropriate treatment for Mrs. Reath from the following: Intravenous (IV) Digoxin and Lasix, defibrillation, temporary pacing, magnesium sulfate. (Please provide your rationale for your selected treatment choice.)
c) What 3 specific findings would directly account for Mrs. Reath’s shortness of breath?
d) The PR interval in the dysrythmia is: 1. Normal, 2. Prolonged, 3. Shortened, or 4. Not measureable? (Please select only one and explain your choice to receive full credit.)
Explanation / Answer
A) The dysrythmia Mrs Reath found in the ECG is Atrial flutter. As we could found the abnormality in P wave rythm. Because the P waves are non rhythmic in nature and it indicates increased beats in atrium.
B)The appropriate treatment is IV digoxin and lasix. Digoxin is anti Arrhythmic drugs which help to treat atrial flutter and other conditions, lasix is a diuretics which used to treat pleural effusion by increasing the urine output.
C The conditions responsible for Mrs Reath Dyspnea is Pleural effusion which makes the lungs harder to work, Increased weight which results in metabolic changes, and history of heart failure which makes the heart hard to pleural effusion.
D) The PR interval in Atrial flutter is not measurable because the rhythm of p waves is not constant and changing frequently.
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