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Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital. Questions: 1. What are the treatment priorities of the registered nurse upon admission? What orders would the RN expect to be included on the standing orders? The treatment priorities of the registered nurse upon admission to the emergency department are as follows; within the first 10 minutes of Mr. Bronson’s arrival to the emergency department begin a 12 lead ECG. Assess Mr. Bronson’s vitals heart rate, blood pressure, respiratory rate, oxygen saturation, and administer oxygen 2-4 liters via nasal cannula (Sen, B., McNab, A., & Burdess, C., 2009, p. 19). Assess any pre hospital medications, and if he has done cocaine in the last 24 hours. At this time, the nurse should assess Mr. Bronson’s pain quality, location, duration, radiation, and intensity. Timing of onset of current episode that brought him to the emergency room, any precipitating factors, and what relieves his chest pain. Keep the patient NPO, and establish two IV access sites with a large bore catheters running one IV with NS at KVO and morphine sulfate for pain. Initial laboratory testing including a complete blood cell count (CBC), basic metabolic panel (BMP), cardiac enzymes (creatine kinase, creatine kinase-MB, and cardiac Troponin) and repeat in 90 min. Administer antiplatelet ASA 324mg PO (Sen, B., McNab, A., & Burdess, C., 2009, p. 18). Before administering nitroglycerin 0.4 mg SL (every 5 minutes up to three doses) reassess blood pressure if systolic <90 mmHg, patient has used cocaine in the last 24 hours, or taking PDE-5 inhibitors do not administer. Thrombolytic therapy should be implemented within 30 minutes from the patient’s arrival to the emergency department, and if they are a candidate for cardiac catheterization it should be done within 90 minutes from the patient being admitted to the hospital. Delay on either therapy option increases the risk of mortality (Kosowsky, Yiadom, Hermann, & Jagoda, 2009, p. 10). 2. Explain how oxygen via nasal cannula benefits a patient in chest pain.
Epinephrine can be added to NE if needed to maintain acceptable BP, or substituted if necessary. Vasopressin (0.03 units/min) can be used as an adjunct to increase MAP,or to lower NE dose; it should not be used as a single agent. Dopamine can be used as an alternative to NE, but only in patients meeting criteria due to risk of arrhythmias; low dose dopamine not to be used for renal protection. Phenylephrine not recommended in most cases; can be utilized if NE leads to serious arrhythmias, CO is known to be high yet BP continues to be low, or as salvage therapy when MAP target is not achieved by other means. An arterial cath should be placed ASAP in patients who require vasopressors. Inotropes can be added to vasopressors or used alone, with a doubatmine trial of up to 20 mcg/kg/min as an option if myocardial dysfunction is suspected by elevated cardiac filling pressures and low CO, or if hypoperfusion is still evident although intravascular volume and MAP are at goal. Bicarbonate should not be used in patients with pH greater than or equal to
A 61-year-old gentleman was admitted on 25/1/2016 to Letterkenny General Hospital with central chest pain after history of a fall. He also had drastic weight loss and loss of motor and sensory function. He walks with the aid of a walking stick as he has problems walking due to his lower limb weakness. The patient was a heavy smoker of 90 pack years (3 packs/day for 30 years) and stopped nine years ago. He stopped drinking seven years ago. He is married and lives at home with his wife. He works as a plasterer. He has a strong family history of ischaemic heart disease and type 2 diabetes mellitus. Two of his brothers had coronary bypasses and stents. His father died of a myocardial infarction. Two of his brothers are also type 2 diabetics. During
The most important elements of the guidelines are organized into two “bundles” of care (Angus, 2013). The first “bundle” is for within the first 3 hours sepsis is suspected. The first thing you would do is measure the lactate level. The second thing is obtaining blood cultures prior to administration of prescribed antibiotics. You administer broad spectrum antibiotics in patients with septic shock. The risk of dying increases by approximately 10% for every hour of delay in receiving antibiotics. The last thing you would do for the 3 hr “bundle” is fluid resuscitation: administer 30 mL/kg crystalloid for hypotension or lactate ≥ 4mmol/L (Subtle Signs of Sepsis, 2017). The second “bundle” is for within the first 6 hours sepsis is suspected. The nurse would do the same protocol for suspected sepsis within 3 hours and continue for more advanced treatment. The next thing you would do is administer vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a MAP ≥ 65 mmHg. For persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥ 4 mmol/L (36 mg/dL), reassess volume status and tissue perfusion and document findings. After initial fluid resuscitation, repeat focused exam, including pulse, capillary refills, vital signs, cardiopulmonary assessment, and skin (Subtle Signs of Sepsis,
In a nursing home it would be the same as in hospital, the only deference would be if the person has a NFR and it is discussed at handover, even still the patient would still be made comfortable and oxygenated in both care settings (Chrisp & Taylor, 2011)
B.V. is a 42 year old male patient admitted for severe angina chest pain. He previously had coronary artery bypass surgery a month ago. His incision site from the surgery was dry, intact with no inflammation present. He currently was not on any pain medications upon admission. He tested positive for hepatitis C and was homeless. He had a history of drug and alcohol abuse and left hip replacement. He is currently taking medications for hypertension and diabetes through Medicare. When getting report on the patient, the nurse stated that the patient kept asking for pain medications every hour but didn’t look like he was in pain. He was in a comfortable position in bed while laughing and watching television. The previous nurse thought the patient just wanted pain medication since he is previous drug addict. This situation reminded me of what I learned in Medsurge about trusting your patient if they
759. Mr. Miller is likely presenting with an acute myocardial infarction. Based on his past medical history of hypertension, hyperlipidemia, obesity, and diabetes, along with his current symptoms of chest pain, shortness of breath, pale skin with beads of sweat on the forehead, as well as elevated lab 's Troponin, CK, and CK-MB, he is most likely presenting with an acute myocardial infarction.
This clinical week started out very interesting as I had a patient who had a cardiac catheterization procedure schedules. I had the opportunity to gain insight on pre-procedure nursing tasks and interventions as well as post –procedure. The patient had been admitted due to chest pain and an Echo test conducted showed aortic vulvar insufficiency. This led to the need of cardiac catheterization a procedure performed to visualize heart structure and blood vessels under a fluoroscopy to further asses this condition. Before the procedure the nurse called the interpreter on the IPad to interpret the patient teaching regarding the procedure including asking about allergies to iodine or seafood and encouraged questions from the patient. The nurse then
Dr. Murray, the chief resident who arrived around 8:00pm, charted Lewis’ heart rate as normal and noteds a probable ileus; however, nursing documentation at the same time recorded a heart rate of 126 beats per minute (Monk, 2002). Subsequent heart rates at midnight and 4:00am arewere charted as 142 and 140 beats per minute respectively without documented intervention (Monk, 2002 ). On Monday morning Lewis noted that his pain suddenly stopped after being very constant and staff charted that they were unable to get a blood pressure recording in either arm or leg from 8:30-10:15am despite trying multiple machines (Monk, 2002; Solidline Media, 2010).
Ally's choose to stop taking his antihypertensive mediction the past year because he was feeling better has caused hypertension putting pressure on the aorta. Due to not taking his antihypertension medication for such a long period of time, has made Dr. Ally's heart work harder, which makes the heart muscles work harder and the heart muscles tend to become bigger and thicker. The condition has caused the heart muscles to perform its pumping function making the fluids to flow back to the lungs causing shortness of breath (WebMD, 2017) Dr. Ally tires easily because of inefficient blood supply to the body cells.
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
Douglas Anthony in one of the hospital in Orlando Florida on July, 2015 this patient brought to the hospital. Patient was having severe pain in the upper part of the body and was crying in the waiting room. Receptionist and other hospital members were busy in dealing with other patients. Mr. Douglas had to wait for long time to get register in electronic record of the hospital. He was sent to the emergency room where doctor examined him for stomach pain. While checking Mr. Douglas Doctor asked him about the medical history of the stomach pain. Due to language and communication problem doctor referred him to physician with his case history. Physician checked him and send him for the Lab tests. After reading the test reports physician diagnosed him for cardiovascular
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
While taking care of my patient on the cardiothoracic intensive care unit, I assisted another nurse who was helping her seventy-one year old patient ambulate to promote circulation and decrease the patient’s chance of developing pneumonia. It also helps the patient to build strength and confidence after such a major surgery like this patient underwent. This patient had come in with non-ischemic cardiomyopathy and had a history of cocaine and alcohol abuse, atrial fibrillation, mitral regurgitation, and hypertension. She had a left ventricular assistive device placed, and ten days after the device had been placed, she was diagnosed with H1N1, had a tracheostomy performed, and was placed on the ventilator. Since she had to wear a mask when outside of her room and had a tracheostomy, it was really difficult to understand the patient’s needs, and this was very concerning to me.
Registered Nurses have many responsibilities. They work with many sick patients that vary in age. To begin, registered nurses are in charge of providing patients with treatments and medications. Also, registered nurses are responsible for recording patients medical information, vital signs, and progress. Without accurate records patients may be given the wrong treatment. Finally, registered nurses are responsible for examining patients and making sure proper nursing care is provided (“Task List” 1). While registered nurses are responsible for many other tasks, these three areas of nursing is the most important. Patients must be treated in a correct manner, and should feel protected while spending time in