Question

A 76years old known hypertension was rushed to the hospital emergency with a history of sudden severe chest pain. She was found breathless with pedal pitting swelling. The BP is 90/60mmHg.

1. Describe your diagnosis for the patient

2. State the observation you would make on the patient on arrival

3. State four laboratory you will perform to confirm diagnosis

4. With nursing care plan, describe your nursing intervention

Answer 1

I hope you will rate my answer positively --

1. Here in this question as described patient is hypertensive , history of suden severe chest pain and also found breathlessness with pedal pitting edema or say swelling.so I think diagnosis would be pulmonary edema, or however edema may be a sign of a more serious underlying medical condition includes congestive heart failure and if their is persistent leg pain and swelling can indicate a blood clot deep in vein called deep vein thrombosis .

2. On the arrival of patient we oberve -

On physical examination the findings are agitation, irritability, excessive sweating, cold extremities, cynosis of upper lip.

Blood pressure is also raised ,as patient is hypertensive, respiratory rate increases, patient is having pedal pitting edema.severe chest pain and breathlessness is also present.

Q3. Laboratory investigation done are -

Initially we would go with blood investigation include CBC, pulse oximetry, serum electrolyte.

ECG done to see ischemic changes and rthym abnormalities.

In radiologic investigation - chest x ray for evaluation of pulmonary edema.

Echocardigraphy , and cardic catheterization.

Q4. Nursing interventions are -

1. Monitoring of all vital signs for the patient.

2. Help the patient relax to promote the oxygenation.

3. Place the patient in high Fowler's position to enhance the lung expansion.

4. Asses the patient condition frequently.

5. Ascultate the lung fields for breathe sound and be alert for crackle sound.

6. Monitor oximetry, ABG results, ECG.

7. assess the sign of hypoxia, headache, etc.

8. Keep ready emergency equipment.

9. Keep environment calm and quit.

10. Give advice for lifestyle modification, diet modification.

11. Provide councelling and health education to family and patient.

Thankyou.