Question

The patient is a 60-year-old white female presenting to the emergency department with acute onset shortness of breath. She is able to speak in short sentences only. Symptoms began approximately 2 days before and have progressively worsened. Patient has a history of hypertension and COPD. She weighs 220lbs. Vital signs as follows T98.6, HR 122, RR 28, BP 168/90Initial exam, patient unable to breathe comfortably in a supine position. Sitting upright in bed. Cap refill 8sec-Lower extremities 4+pedal edema JVD positive in semi –Fowlers position Generalized edema noted- Lung sounds: crackles and rhonchi bilaterally on inspirationMedications: Spiriva inhaler

2 puffs Q4h PRN for SOB Advair 2puffs BID Vasotec 20mg PO bid Lasix 20mg BID What do you believe is happening to this patient? What independent actions would you initiate as a nurse? What orders from the physician do you believe this patient may need to relieve her symptoms? What questions might you ask this patient?

Answer 1

a):-What do you believe is happening to this patient?

patient is already having the history of COPD and hypertension ,according to the symptoms patient exhibit its looks like heart failure

Symptoms

Heart failure signs and symptoms may include:

>Shortness of breath ,when you exert yourself or when you lie down

>Fatigue and weakness

>Swelling in your legs, ankles and feet

>Rapid or irregular heartbeat

>Reduced ability to exercise

>Persistent cough or wheezing with white or pink blood-tinged phlegm

>Increased need to urinate at night

>Swelling of your abdomen

>Very rapid weight gain from fluid retention

>Lack of appetite and nausea

>Difficulty concentrating or decreased alertness

>Sudden, severe shortness of breath and coughing up pink, foamy mucus

>Chest pain if your heart failure is caused by a heart attack

B):-What independent actions would you initiate as a nurse?

priority nursing actions:-

1:- place the client in high Fowler's position

2:-administer oxygen as prescribed

3:-assess the client lung sound

4:-ensure intravenous access is in place

5:-prepare for the administration of diuretic and morphine sulfate

6:-insert a foleys catheter as prescribed

7:-prepare for intubation and ventilator support

8:-Documentation of action taken and client response

C:-What orders from the physician do you believe this patient may need to relieve her symptoms?

Physician may advise to :-

Put the patient on Bipap administer oxygen if needed patient is not coping then endo tracheal intubation and mechanical ventilation

give sedatives,diuretics ,anti hypertension medications ,inotropes , nebulizers ,

insert foleys catheter

diagnostic tests like ECG,ECHOCARDIOGRAPHY,Arteral blood gas

What questions might you ask this patient?

>When did your symptoms begin?
> What and where are your symptoms? What triggers your symptoms?
>What triggers dyspnea and fatigue?

>How long do the symptoms last?
> Have you experienced unintentional weight loss or gain, or a recent decrease in
appetite?
>Have you experienced palpitations, syncope, or ICD shocks?
>Do you have sleep problems?
>Have you experienced symptoms of transient ischemic attack
thromboembolism?
> What medications are you taking? Do any of your medications exacerbate your HF?
>Tell me about your diet. Are you on a low sodium diet?
>Are you compliant with your medical regimen?
>Do you have a first degree relative with heart failure