Question

The patient is alert and oriented x 3, JVD is present, lungs with crackles bilaterally, and apical pulse is irregularly irregular tachycardia. Pulses remain palpable in all extremities. VS – 37.0 C – 136 – 20 – 80/40 – 95% 2LNC. ECG shows: Case Study Image #2 What does the ECG indicate? What orders will you anticipate and why?

Answer 1

1. Patient have bilateral crackles in lungs( due to excess fluid collection in the large airways), jugular vein distension( due to compression of superior venacava) and irregular tachycardia( in order to increase cardiac output). These all indicate the patient is affected with right side heart failure.

2. The ECG changes will be,

Right axis deviation >90degree

Tall R waves in RV lead, deep S wave in LV lead

Slight increase in QRS widh

ST segment depression and T wave inversion in precardial leads (V1-V5)

3. Orders can be expected:

Take ECG, ECHO, bood studies like ABG analysis, liver and renal function test- To know the condition of the patient

Put central line- To monitor central venous pressure

Diuretics- To reduce excessive preload

Pulmonary vasodilators. E.g., Beta adrenergic blockers, ACE inhibitors - to reduce after load

Inotropes like mild dose of dobutamin, Milirinone- to improve cardiac contractility

Epinephrine- to improve cardiac out put

Inhalation of Nitric oxide - to relax blood vessels

Oxygen administration - to maintain saturation

Elevate head end of the patient and provide cardiac table- To reduce shortness of breath.