Question

In: Biology

You are just getting caught up with your work when you receive the following phone call:...

You are just getting caught up with your work when you receive the following phone call: “Hi, this is Deb in the ED. We’re sending you Linda, a 53 y/o woman with a PMH of CAD, DM, HTN, and Dyslipidemia. Her daughter reports that she’s become increasingly weak over the past couple of weeks and has been unable to do her housework. Apparently she has been C/O swelling in her ankles and feet by late afternoon (“she can’t wear her shoes”) and has nocturnal diuresis Her daughter brought her in because she has C/O heaviness in her chest off and on over the past few days but denies any discomfort at this time. The daughter took her to see her family physician, who immediately sent her here. VS are 146/92, 96, 24, 37.2°C. She has an IV of D5W at KVO in her right forearm. Her labs are as follows: Na+ 134 mmol/L, K+ 3.5 mmol/L, Cl- 103 mmol/L, HCO3- 23, BUN 13 mg/dl, creatinine 1.3 mg/dl, glucose 153 mg/dl, WBC 8.3 thou/cmm, Hct 33.9%, Hgb 11.7 g/dl, platelets 162 thou/cmm. PT/INR, PTT, and urinalysis (UA) are pending. She has had her CXR and ECG, and her orders have been written. 5. Given the previous information, which of the following orders can you anticipate as appropriate for this patient? Carefully review each order to determine whether it is appropriate or inappropriate as written. If the order is appropriate, place an “A” in the space provided; if the order is inappropriate, place an “I” in the space provided and change the order to make it appropriate. Also provide any other orders that may be appropriate for this patient.

____________            Routine VS

____________            Serum magnesium STAT

____________            Up ad lib

____________            10 g sodium, low animal fat diet

____________            Change IV to NS at 100 ml/hr.

____________            Cardiac enzymes on admission and q8h x24 then q AM

____________            CBC (hemogram), chem 7, and lipid profile in morning

____________            Schedule for abdominal CT scan for morning.

____________            Heparin 10,000 units SQ q8h

____________            Docusate sodium 100 mg PO qd

____________            Ampicillin 250 mg IVPB q6h

____________            Furosemide 200 mg IVP STAT

____________            Nitroglycerin 0.4 mg 1 SL q4h prn for chest pain
                                    Call house officer (HO) if no relief

Solutions

Expert Solution

A: Routine VS:

I: Serum magnesium STAT

I:Up ad lib

I: 10 g sodium, low animal fat diet

I: Change IV to NS at 100 ml/hr.

A: Cardiac enzymes on admission and q8h x24 then q AM

A: CBC (hemogram), chem 7, and lipid profile in morning

I:Schedule for abdominal CT scan for morning.

I:Heparin 10,000 units SQ q8h

I:Docusate sodium 100 mg PO qd

I:Ampicillin 250 mg IVPB q

A:Furosemide 200 mg IVP STAT

A: Nitroglycerin 0.4 mg 1 SL q4h prn for chest pain
A: Call house officer (HO) if no relief

OTHER APPROPRITAE ORDERS CAN BE:

Plan frequent rest periods

Monitor vital signs and O2 sat at rest and during activity

Fluid restriction: keep accurate intake and output

Beta blocker therapy

ACE inhibitor therapy

Low sodium diet

Ionotrpes, digoxin

CPAP if needed (continous positive airway pressure)


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