Patient C. Z Case Study Nursing

Furosemide 80 mg is a potent diuretic, which may cause the loss of potassium and magnesium.

Maureen shows clinical manifestations such as hypotension (BP 80 mmHg systolic), tachycardia (HR 120 bpm and irregular), tachypnea (Resps 28 bpm), SaO2 unreadable, capillary refill time >4secs, temp 36.5°C (core) indicating the signs of hypovolaemia (Perner & Backer, 2014, p. 614). With the reference of Mrs. Hardy’s medical condition, such as arthritic knees and atrial fibrillation (INR 2.7), she is under diclofenac Acid 50mgs PO BD and warfarin 2mgs PO mane respectively (Jordan, 2010, p. 567; Zacher, et al., 2008, p. 930). Diclofenac is a

1 Understand the requirements of legislation and agreed ways of working to protect the rights of individuals at the end of life.

A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin.

The patient's comorbidities include Hypertension, hyperlipidemia, CAD, and GERD. The patient had a CABG operation a few days back from admission day on 4-10-2017. In addition to the CABG surgery, other procedures such as TEE, cardiopulmonary bypass, vein harvest, and a thoracotomy with a chest tube and JP drain. Significant surgical procedures also include angioplasty and left and right knee arthroplasty.

D.D is a 16 yr old male who was in his usually state of health until he developed right-sided abdominal pain approximately 5 days prior to arriving at the hospital. His pain progressively worsened and spread throughout his abdomen. He also had nausea non-bloody, non-bilious vomiting, some diarrhea, as well as fevers, when pain did not improve he presented to ER. He was admitted and diagnosed with sepsis and perforated appendicitis. He had a laparoscopic appendectomy and a central venous catheter was placed. Following surgery he was then transferred to the med-surg floor. His parents are both Spanish speaking and at the bedside.

(Ramani, Uber, & Mehra, 2010). My grandmother had heart failure and I saw how she had a time trying to breath and her ankles were swollen all the time. She thought the medicine was hurting her instead of helping. She took several different medications to try to control her symptoms, but she eventually succumbed to heart disease.

Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.

Two types of data were collected through surveys, both before and after implementation of the combined approach (Sand-Jecklin and Sherman,2014). The first data was on nurses’ point of view with regards reporting process, and the second on patients view regrading nursing care. The baseline survey included 233 patients and 148 nurses, while the survey three months into the implementation period included 157 patients and 98 nurses. The final survey, 13 months into the impanation, was completed by 154 patients and 54 nurses. The patient survey also included responses from patient families. These were 70, 72, and 53 responses for baseline survey, three-month postimplementation surveys, and 13-month postimplementation surveys.

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

The profession of nursing includes: promoting health, preventing illness, as well as providing care. NUR 102 teaches student nurses, like myself, a wide range of information and knowledge needed in order to become a successful nurse and also aids in the preparation for clinical placement. Nonetheless, this course teaches essay writing, critical thinking, nursing theories, as well as the roles and responsibilities that I will have as a nurse.

Critical care nurses provide advanced nursing care for patients in critical or cornary care units. The preparatin required to become a critical care nurse education wise most occupations require training in vocational schools, related on-the-job experience, or even a associates degree. The job training required however employees usually need any where from one to two years of training involving both on-the-job and informal training with experiened workers.

You had a recent episode of lower leg edema (swelling) which your primary care physician prescribed Lasix (medicine to get rid of fluid). You vital signs were within normal limits and there was no oxygen saturation (rest) provided. Your electrocardiogram (recording of your heart activity) was Sinus (normal). In emergency room you received 30 milligram of Lovenox (blood thinner) and Methylprednisolone (medicine to help with breathing). You were admitted, started on aspirin, Cardiac enzymes (test) were done and your first troponin (test) was negative (no other results provided). You were continued on Prednisone (medicine) 10 milligram daily; restarted on Coumadin (blood thinner), Diltiazem (medicine), and a low salt diet was recommended as well as you received Albuterol via a nebulizer (breathing treatment) every 4 hours. Your pulmonary (breathing specialist) consult states that the shortness of breath was most likely due to deconditioning (changes in body with inactivity), obesity (over weight), and less likely due to Sarcoidosis (inflammatory disease). Chest pain syndrome was musculoskeletal (muscle-bone) in origin as it was reproducible (pain present when area is pushed

The very first and easily the most important problem for this patient are the medications. Both the Lasix and Lanoxin have been doubled as these are new medications written by the hospital physician and he

There are a plethora of treatments available for patients with heart failure including but not limited to diuretics, ACE inhibitors, angiotensin receptor blockers, and oral nitrates. The Vasodilator heart failure (V-HEFT) studies show that enalapril has less cumulative mortality among study participants when compared to patients taking a combination of isosorbide dinitrate and hydralazine. (MGMT) This is not to say that the combination of isosorbide dinitrate and hydralazine is not efficacious because when compared to placebo, mortality rates improved with the combination treatment.