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Mrs. Doe, a 67-year old female, presents to the Emergency Department (ED) after visiting her primary physician complaining of general fatigue for 4 days, shortness of breath, and abdominal discomfort. Mrs. Doe’s medical history includes hypertension and coronary artery disease. She had a previous 89% LAD blockage and 52% RCA blockage with stent placements in both.

 

What initial nursing assessments need to be performed for Mrs. Doe?

 

What diagnostic tests do you anticipate the provider to order? 

 

 

 

Bilateral crackles and tachycardia is present upon further assessment. Cardiomegaly is seen on her chest X-ray as well as and bilateral pulmonary edema. An ECG revealed atrial fibrillation. Vital signs were as follows:

BP 148/62 mmHg Urine Yellow and Cloudy

HR 106-124 bpm and irregular 

Temp 37.3°C

RR 26-33 bpm 

BUN 18 mg/dL

Cr 1.3 mg/dL

 

H/H 11.8 g/dL / 36.2%

 

Ht 175 cm 

 

LDH 705 U/L

 

Wt 78 kg 

 

BNP 843 pg/mL

Mrs. Doe was admitted to the cardiac telemetry unit.

Mrs. Doe states that this weight is approximately 3 kg more than it was 3 days ago.

 

What is the significance of Mrs. Doe’s weight gain?

 

 

 

What medications do you anticipate the provider ordering for Mrs. Doe? Why?

 

 

Physiologically what is happening to Mrs. Doe?

 

 

What medications should help decrease Mrs. Doe’s preload, afterload, and will improve her contractility? 

 

 

Mrs. Doe was transferred to the CCU for hemodynamic monitoring and aggressive therapy. Her Central Venous Pressure (CVP) was found to be 19 mmHg, Cardiac Output was 4.5 L/min, Cardiac Index was 2.3 L/min/m2. She has been placed in high-fowler’s position, and her SpO2 is now 96% on 4L nasal cannula. Mrs. Doe received Furosemide 80 mg IV and Digoxin 0.5 mg IV. 

 

What is the expected outcome of administration of Furosemide? Digoxin?

SCIENCE
HEALTH SCIENCE
NURSING
NURSING NS255