Compare a patient with an ejection fraction of 45% and a BNP of 900…
Question Compare a patient with an ejection fraction of 45% and a BNP of 900… Compare a patient with an ejection fraction of 45% and a BNP of 900 with a patient with an ejection fraction of 30% and a BNP of 200. Explain which patient do you expect to have more severe symptoms and why?Questions # 2-6 refer to the case study below.Jerry Williams is a 62-year-old obese (weight 269 lbs, BMI 35.2) male with a history of diastolic heart failure and type II diabetes. Last evening, he began having difficulty breathing with activity. He thought he might be getting a cold because he had a runny nose. He reports more swelling in his lower legs the past couple days. He woke up this morning with increased difficulty breathing when he woke up and his wife called 911.Paramedics report that his initial VS: HR:92 RR: 28 BP: 108/70 O2 sat: 80% on room air with scattered expiratory wheezing bilat. He was placed on oxygen by facemask and albuterol nebulizer administered with some improvement in his breathing. His RR is now 24 upon arrival to the emergency department.Current VS: BP: 102/ 68R: 24 (reg)P: 105 (reg)T: 98.2 F/36.8 C (oral)O2 sat: 93% 6 liters n/c Reported by EMS BP: 108/70R: 24P: 92 (reg)T: 98.8 F37.1 C (oral)O2 sat: 94% 4 liters n/cCurrent Assessment:GENERAL SURVEY:Appears uncomfortable NEUROLOGICAL:Alert & oriented to person, place, time, and situation (x4); muscle strength 4/5 in both upper and lower extremities bilaterally.HEENT:PERRLA, sclera white bilaterally, oral mucosa pink and moist.RESPIRATORY:Breath sounds coarse crackles in bases bilat. equal inspiration and expiration in all lobes anteriorly, posteriorly, and laterally, slightly laboredrespiratory effort.CARDIAC:Pale/pink, warm & dry, 2+ pitting edema in feet and ankles, heart soundsirregular, pulses + 2 , radial, +1 pedal/post-tibial landmarks, <3 sec. cap refill. Heart tones audible, S1, S2, S3 with no murmurs. Unable to assess JVD due to obesity/thick neckABDOMEN:Abdomen round, soft, and nontender. BS + in all four quadrants GU:Voiding without difficulty, urine clear/yellowINTEGUMENTARY:Skin cool, dry, intact, normal color. No clubbing of nails, cap refill <3Diagnostic Results:Basic Metabolic Panel (BMP) Na: Current 133 Most recent: 138K: Current 4.9 Most recent: 4.2Glucose: Current 145 Most recent 118Creat: Current 2.9 Most recent 2.2Complete Blood Count (CBC) WBC: Current 4.8 Most recent 5.8% Neuts: 68 Most recent 65HGB: Current 9.9 Most recent 10.2PLTs: Current 228 Most recent 202CardiacTrop: Current 0.10 Most recent 0.12BNP: Current 1855 Most recent 155Mg: Current 1.9 Most recent 1.8PT/INR: Current 1.0 Most recent 1.1 Radiology: Chest x-ray with bilateral diffuse pulmonary infiltrates consistent with pulmonary edema ECG:Highlight the information in the scenario as follows. o Highlight in in yellow if it is an immediate concern. o Highlight in blue if it is not an immediate concern but does requires follow up later o Highlight in green if it is not relevant to the patient's condition at this time 4. The nurse has just received patient from EMS and is waiting on the physician to evaluate thepatient. Prioritize 5 interventions that the nurse needs to complete at this time.Priority Intervention 5. The physician orders the following medications. Determine whether the order is emergent (now), urgent (done within an hour) or routine (done before the end of the shift) or contraindicated.Physicians OrdersEmergent Urgent Routine ContraindicatedDiltiazem 10 mg IV x1Furosemide 80 mg IV BID Carvedilol 25 mg PO BID Levothyroxine 112 mcg PO dailyAtorvastatin 40 mg PO at bedtimePT/PTT nowHeparin per protocolMedium Dose Protocol Atrial Fibrillation, Pre- operative Anticoagulation or Mechanical ValveX Heparin Bolus 70 units/kg IV = _____units (max 5,000 units)X Heparin Infusion: ≤ 66 kg = 15 units/kg/hr > 66 kg = 10 mL/hr X PTT-heparin 6 hrs after infusion start, dose adjustment orsingle PTT in target range (QAM after 2 consecutives= 50-75) 6. The patient is most at risk for ______________________ as evidenced by the patent’s_________________________ Health Science Science Nursing NURSING 250 Share QuestionEmailCopy link Comments (0)
