Question

The patient is placed in a room. He is diaphoretic, and appears anxious. He is alert and oriented and able to answer questions. Lungs have scattered crackles bilaterally. No JVD is present. Heart sounds indicate a systolic ejection murmur and S4. Bowel sounds active and abdomen is non-distended. Pulses are palpable in all extremities. VS – 37.0 C – 92 – 18 – 170/100 – 94% RA. Chart View Lab Values Metabolic Panel Sodium 142 mmol/L Potassium 4.5 mmol/L Chloride 97 mmol/L CO2 27 mmol/L BUN 13 mg/dL Creatinine 1.2 mg/dL Glucose 110 Coagulation Profile Partial thromboplastin time 35 sec Prothrombin time 12 sec International Normalized Ratio 1.0 Fibrinogen 180 mg/dL Cardiac Markers CK-MB 2.0% CPK 85 IU/L Troponin I 0.0 ng/mL CBC with Differential WBC 7,500 K/uL Neutrophils 60% Band forms 4% Basophils 0.45% Eosinophils 1% Lymphocytes 30% Monocytes 4% Hemoglobin 14.0 g/dL Hematocrit 40.2% Red blood cell 4.8 M/uL Platelet 200,000 K/uL What assessment data and labs values are of concern? Why?

Answer 1

Patients vital signs increased blood pressure. His electrolytes and coagulation profile are normal. Blood sugar is under controlled. Cardiac Markers are within the range. His CBC is within the normal count. But the patient has Scattered crackles bilaterally and also systolic ejection murmur and S_4. It is a systolic sound associated with the ventricle. The causes may be due to ischemic, hypertensive, cardiomyopathy, heart failure. It also indicates the potential problems of aortic stenosis or mitral regurgitation. Crackles sounds are due to leakage of fluid into the lungs.To confirm the diagnosis, additional data and lab values are needed.

Assessment Data:

• Collect the patient detailed history of past and present conditions. To Know the history of previous health disorders.
• Assess for chief complaints of the patient such as chest pain, shortness of breath, dizziness, fatigue.
• Assess the pulses. Note the differences between the radial pulse. Pulse alternans indicate left-sided heart failure and pulse paradoxus indicate pericardial disease.  
• Assess the jugular veins fo any distension.
• Assess the legs for edema.
• Assess the type of breathing pattern to know the shortness of breath.

Lab values:

• ECG - to know the abnormal rhythm.
• Ventricular perfusion scan to know the increased blood pressure in the lungs.
• Transesophageal echocardiogram to detect the leakage.
• Echocardiogram to detect structural problems within the chambers of the heart.
• Chest X-ray to detect the heart size and to detect the abnormalities or fluid present in the lungs.
• Cardiac catheterization if needed.