44-year-old male ETOH Abuse Smokes 1ppd for 30 years PMH: COPD, DM, HTN, CHF, Cirrhosis, Ascites,...

44-year-old male

ETOH Abuse

Smokes 1ppd for 30 years

PMH: COPD, DM, HTN, CHF, Cirrhosis, Ascites, BPH

PSH: TURP, Repair of right inguinal hernia, Cholecystectomy

Allergies: PCN

The above patient came to the ED c/o, spitting up blood and altered mental status. VS 103.5 – 189/103 – 114 – 26 – 89% NRB. The patient was intubated and vented, and NGT was placed. When lungs were auscultated, there crackles heard halfway up. Line and labs were done, and IVF 0.45 NS started at 60ml/hr. BC x 2 drawn, and Vancomycin 1gm IV given. Also given was Tylenol 650mg PO, Labetalol 100mg IV, Lasix 40mg IV. FC placed to bedside drainage with hematuria returned. Labs returned. WBC 28.6, H/H 7.3/18.6, PT 28, PTT 66, PLT 126, Ammonia 58, BNP, 158, Bands 10.5, Glucose 621, K+ 6.8, HgbA1C 10.9, CK 7.4 and Trop 1.6. EKG shows a STEMI, and CXR shows RUL pneumonia and pleural effusion. The patient is intubated via rapid sequence intubation and placed on a vent. Sedation is done with fentanyl and propofol. The patient went to cardiac cath for a PCI. 2 stents placed successfully for 95% blockage. The patient is to be transferred to ICU.

EKG in ED.

question. upon transfer to the ICU, what would you the nurse expectant anticipate in the following scenario?

Expert Solution

Based on the scenario the ICU nurse should be prepared to take care of post PCI patient on ventilator support.

Keep post operative ICU bed ready to receive the patient
Keep Cardiac Monitor,Ventilator,Crash cart,12 lead ECG machine and Suction ready

After receiving the patient Monitor for:

Monitoring for bleeding ( including retro peritoneal bleeding) pseudoaneurysm formation,Infection,arrhythmias,contrast medium- induced renal failure,and ECG changes that might indicate cardiac ischemia or myocardial infarction.
The patient may be receiving anticoagulation or anti platelet therapy ( or both)If anticoagulants have been administered pre catheterization the patient is at higher risk of bleeding.All patients will have received heparin during the procedure
Observation for complications of PCIincluding:
Assessment of puncture site for Bleeding:- check pressure dressing for oozing or bleeding from puncture site and mark the size of bleed if possible
Haematoma- Assess site for swelling,redness and pain and mark the size of hematoma is possible.( It can indicate bleeding into the thigh,pelvis or retro peritoneal space.
Infection- Assess site for heat,pain and redness.Also Assess for other signs of infection including an increase in temperature,tachycardia,and rigors.
Ecchymosis- Assess skin around site for purple discoloration.
Coronary artery dissection: may require an immediate coronary artery bypass,symptoms include chest discomfort or pain,arrhythmias,ECG changes indicating ischemia or infarction,In- stent restenosis can occur within 48 hours or more gradually over 2-3 months.
Monitor patients 12 lead ECG for changes,and be alert for chest discomfort or pain,which may indicate in- stent restenosis,
Monitor for reperfusion injury( characterized by chest discomfort,pain,or arrhythmias such as premature ventricular contractions) and coronary artery spasm
Care of a patient on mechanical ventilation
FC care,NG tube care.

Nightingale answered 1 year ago

Mr. H is a 64 year old male with a history of COPD, HTN, and Type...

Mr. H is a 64 year old male with a history of COPD, HTN, and Type 2 DM. he just arrived this morning from the ED with a diagnosis of uncontrolled HTN (admitting BP 220/110), and chest pain. The symptoms that brought him into the ED were severe morning H/A with occasional vomiting x3 days, SOB, and chest pain. When you examine him you notice a large bruise on his right elbow and hip. He relays history of a fall...

60 years old ,male , DM Type 2 , HTN since 20 years ,smoker ,family history...

60 years old ,male , DM Type 2 , HTN since 20 years ,smoker ,family history of IHD , Pt said i have shortness of breath increasing by supine position and decreased with sitting position ,like heaviness,intermittent ,started yesterday at 6pm,associated with dry cough ,sleep at night using 4 pillow to sleep Pt said ihave swelling in my rt and lft foot,ankle worsen when stand or dangling the leg ,decrease with elevate the leg since one month and increase in...

History of Present Illness: 60-year-old male with past medical history of alcohol abuse, COPD/emphysema and reflux...

History of Present Illness: 60-year-old male with past medical history of alcohol abuse, COPD/emphysema and reflux esophagitis in the past presents to the emergency department with c/o severe shortness of breath going on for the past 5 days. Patient states that he was at home and has not left his home. Patient states he lives with his brother and his brother have not left the home because they are both following the guidelines to stay at home. His brother has...

Age: 85 years Gender: male diagnosis: HTN+CHF Rx Indapamide 2.5 mg daily Bisoprolol 5 mg bid...

Age: 85 years Gender: male diagnosis: HTN+CHF Rx Indapamide 2.5 mg daily Bisoprolol 5 mg bid Digoxin 0.25 mg bid Aspirin 81 mg od Nifedipine 10 mg od Note: if bisoprolol not available in your pharmacy , what in the alternative? according to this prescription find the mistakes, the interaction, dose , the toxicity level , antidotes , the counselling and what the suitable medication for this patient ?

A 57 year-old male with history of HTN and HLP presents to your office with complaints...

A 57 year-old male with history of HTN and HLP presents to your office with complaints of transient chest pain during exertion. He denies associated nausea, diaphoresis however does complain of increase shortness of breath and dyspnea on exertion. His chest pain is substernal and does not radiate and seems to alleviate after 5-10 minutes with rest. The last occurrence of pain was one week ago. Pt denies palpitations, near syncope or syncopal episodes. 1. How would you classify the...

Jose Bretado is an 70 year old male w/no reported PMH. Went to bed last night...

Jose Bretado is an 70 year old male w/no reported PMH. Went to bed last night at 2000, when patient was last known normal. This morning, patient's roommate found him down with Left sided weakness at 0700 and called EMS. Upon their arrival, patient found to be tachycardiac to the 180s and given adenosine. Upon arrival to ED, patient found to be in afib. CT-A showed a Right MCA occlusion. Stroke Code activated and patient prepped for possible embolectomy. Significant...

Client Profile Mr. Escobar is a 47-year old male with a history of cirrhosis. He lives...

Client Profile Mr. Escobar is a 47-year old male with a history of cirrhosis. He lives with his wife and teenage sons. His wife brought him to the emergency department today because she noticed that Mr. Escobar had increasing confusion and lethargy and was having difficulty walking. His wife states, ?He is probably acting a little funny because he is sleep deprived. He hasn?t slept very much in the past few days. Case Study Mr. Escobar is afebrile. His blood...

1. Cirrhosis - Mr. Garcia is a 43-year old male who presented to the ED complaining...

1. Cirrhosis - Mr. Garcia is a 43-year old male who presented to the ED complaining of nausea and vomiting x 3 days. The nurse notes a large, distended abdomen and yellowing of the patient’s skin and eyes. The patient reports a history of IV drug use and alcohol use. What initial nursing assessment should be performed? What diagnostic studies might you anticipate for Mr. Garcia? Mr. Garcia’s vitals are stable, BP 100/58, bowel sounds are active but distant, and...

A 66-year-old male with a history of COPD is admitted to the emergency department with shortness...

A 66-year-old male with a history of COPD is admitted to the emergency department with shortness of breath. He is not currently taking any medication for his breathing. The patient states that he usually gets short of breath only upon exertion, but he developed a “cold” several days ago that made his breathing worse. He has been placed on oxygen. The doctor wants him to have breathing treatments. What medication, dose, and route of administration would you suggest? (a) How...

A 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED...

A 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED with complaints of "my skin looks yellow, my stomach hurts, and I feel nauseous". He is taken to CT and a tumor near the pancreas is observed. It appears to be blocking the common bile duct .please answer the questions below Possible Medications (Minimum of 2 medications needed) Clinical Manifestations Subjective: Objective: Possible Nursing Diagnosis (Minimum of 2 needed) Medical Diagnosis Cirrhosis...

Question