In: Biology
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
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)