2. A nurse is caring for a patient with shock of unknown etiology whose hemodynamic…
Another blood pressure and pulse is obtained a few hours later as it was still both high at 148/91 blood pressure and a heart rate of 100. When assessing her routine labs, there is no significant abnormalities noted. After presenting the data to the physician and the physician assesses the patient, it is concluded that M.S. has the medical diagnosis of stage 1 hypertension. According to ATI, stage 1 hypertension is a blood pressure reading of “systolic 140 to 159 mm Hg; diastolic 90 to 99 mm Hg” (ATI, RN Medical Surgical Nursing, pg.411). In the patient care plan, the priority nursing diagnosis is risk for decrease cardiac output related to increased vascular resistance. Another nursing diagnosis in the patients care plan is, knowledge deficit related to lack of knowledge of new diagnosis. In order to get her blood pressure and heart rate to go down, the physician ordered metoprolol…
2. An 56-year-old established patient presents to her doctor's office with chest pain and shortness of breath. The doctor orders an ambulance to take the patient to the ED to be checked out. From the ED the patient is admitted for some tests to determine what the problems are. The history and exam performed were comprehensive and the MDM was of moderate complexity…
Explain why this patient’s blood pressure was so low and her heart rate was so high upon arrival at the emergency room.…
Patient X is a 52-year-old man who lives in Bowen Hills, Brisbane. He is an automotive repair man. However, he has recently lost his job and has stayed idle for one year. Recently, he was playing basketball with his eldest son and suddenly developed a substernal chest pressure. When he thought it was just a typical ‘heartburn’, he continued playing. After another 20 minutes, he had an intolerable sharp, nagging chest pain. His left arm became numb. His son verbalised that he looked pale and was sweating a lot. His son called the paramedics which accordingly arrived after 30 minutes and he was brought to Royal Brisbane and Women’s Hospital.…
Mrs. Julia Steel is a patient I have had the pleasure of meeting with recently. As discussed during the appointment, Mrs. Steel is a 72 year old retired, married woman. Collectively, Mrs. Steel's family history includes the following information: one son at the age of 40 who is being treated for high blood pressure, father's record showed background of heart disease and deceased at the age of 90 due to a brain aneurysm, mother's record provided extensive history with heart disease and deceased due to congestive heart failure at the age of 92, brother who passed at the age of 81 due to heart disease, sister at the age of 76 who has suffered multiple minor heart attacks. According to the biographical data collected, her family history exhibits a…
You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.…
The time is 1900 hours. You are working in a small, rural hospital. It has been snowing heavily all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in good weather), have been grounded by the weather until morning. The roads are barely passable. WR., a 48 year old construction worker with a 36 pack year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male pattern obesity (beer belly, large waist circumference) and a barrel chest, and he reports a dietary history of high fat food. His wife brought him to the ED after he complained of unrelieved indigestion. His admission VS were 202/124, 96, 18, and 98.2°F. WR. Was put on O2 by nasal cannula titrated to maintain SaO2 over 90%, and an IV of nitroglycerin was started in the ED. He was also given aspirin 325 mg and was admitted to Dr. A’s service. There are plans to transfer him by helicopter to the regional medical center for a cardiac catheterization in the morning when the weather clears. Meanwhile you have to deal with limited laboratory and pharmacy resources. The minute WR. Comes through the door of your unit, he announces he’s just fine in a loud and angry voice and demands a cigarette.…
The contributing factors began with Mr. B’s admission to the Emergency Room. The Root Cause Analysis, in this case, Mr. B was heavily sedated with IV medication, Hydromorphone, and consequently multiple doses of the muscle relaxant Diazepam. The Root Cause Analysis issue, the nurse should have developed a suitable plan beforehand, administering multiple doses of conscious sedating…
The dilemma is that Mrs. Margie Whitson a patient at Golden Oaks Rehabilitation Center is going through some very hard times after just loosing her son William about a week ago. She has also had to deal with loosing her husband in the past 5 years leading up to this. She is also reflecting back to when she lost her first son to a motor vehicle accident. Margie is having a very difficult time taking this all in and now feels all alone and wants the one and only thing keeping her alive removed. Margie suffered a heart attack 2 years ago that almost took her life and she had to have an electronic pacemaker implanted. The pacemaker is what is keeping her alive by keeping her heart rhythm at a 100% pace. Without the pacemaker she would not be able to live. Now that all of her family is gone she is requesting that her pacemaker be removed so that she can pass and go on to be with her family because she now feels like she has nothing to live for anymore. She has talked to the Rehabilitation Center Administrator Cindy Mackin and has told her what she wants to happen and has requested her to call Dr. Vijay who was the Cardiologist Surgeon who placed the pacemaker in her to remove it.…
PHYSICAL EXAMINATION: Physical exam reveals a well-developed, well-nourished 35 year old white female in a moderate amount of distress at the time of the examination. VITAL SIGNS: Show temperature 97 degrees; pulse 53; respirations 22; blood pressure 108/60. HEENT: Unremarkable except for poor dentation. Neck: Soft and supple. CHEST: Lungs are clear in all ???. HEART: Regular rate and rhythm. ABDOMEN: Soft but positive tenderness of her lower abdominal…
Abby, is 21 years of age and is a female patient who received a permanent atrial-ventricular pacemaker for the diagnosis of sick sinus rhythm, a disorder that leads to periods of tachycardia and periods of extreme bradycardia or sinus arrest. The nurse received the end-of-shift report and arrives at Ms. Abby’s’s room where she assesses the patient’s incision dressing on the upper left chest and it is dry. The patient’s left arm is edematous and ecchymotic and twice the size of the other arm. The patient states that her left arm feels numb and tingling. The distal pulses are present and at baseline. None of the findings were noted in the end-of-shift report.…
PHYSICAL EXAMINATION: VITAL SIGNS: Show temperature 97 degrees, pulse 53, respirations 22, and blood pressure 108/60. GENERAL: Physical exam reveals a well-developed, well nourished, 35-year-old white female in a moderate…
I have a patient coming to ICU from emergency department with diagnosis of severe hypertension and history of ischemic heart disease. The patient was started with infusion GTN at 1cc/hours. In intensive care, the BP persistently increasing and my doctor ordered to increasing the dose of GTN infusion to 5cc/hours. The BP was decreasing down to 120/90mmhg in 15 minute later. The dose of infusion will reduce to 1cc/hours. BP was persistently decreasing to 70/40mmhg. All the team were query why the BP was crashed dramatically. The team ask the patient whether he took antihypertensive drug before coming to the hospital, but he denied it. Then, the person in-charge of the patient noticed that GTN infusion was diluted in 50mg/ 10cc, so it means the dose of GTN infusion was infused to patient in high dose. Patient experienced sweating, giddy, cold and clammy. She immediately stops the infusion and inform the Dr, then Dr started patient on inotrop with double concentration following fluid resusscitation. 1 hour later the BP started to pickup and patient feel better. The inotrop was continued for the whole day and night. The investigated done and found that infusion GTN was wrongly diluted by the junior nurses at emergency department, yet she was mixed up with infusion GTN put in the same column in medication trolley but in different concentration.…