Question

Mrs. A. is a 65-year-old woman with type 2 diabetes who comes into the emergency department; she is short of breath and complaining of neck and shoulder pain. Her blood pressure is 88/55 mm Hg, and her heart rate is 48 beats per minute. The cardiac monitor shows a cardiac rhythm with more P waves than QRS complexes, and the PR interval when the P waves are conducted is 0.16 seconds. The rhythm is noted below: Questions 1. What is your interpretation of the rhythm? 2. What signs and symptoms might the patient exhibit with this bradycardia? 3. What is the initial management of this patient? 4. What additional intervention(s) may be needed? Arial 3 (12pt) Paragraph Font family Font size Mrs. A. is a 65-year-old woman with type 2 diabetes who comes into the emergency department; she is short of breath and complaining of neck and shoulder pain. Her blood pressure is 88/55 mm Hg, and her heart rate is 48 beats per minute. The cardiac monitor shows a cardiac rhythm with more P waves than QRS complexes, and the PR interval when the P waves are conducted is 0.16 seconds. The rhythm is noted below: Questions 1. What is your interpretation of the rhythm? 2. What signs and symptoms might the patient exhibit with this bradycardia? 3. What is the initial management of this patient? 4. What additional intervention(s) may be needed? Arial 3 (12pt) Paragraph Font family Font size 1. Mr. R. is a 66-year-old man who has smoked 1.5 packs of cigarettes a day for 40 years (60 pack-years). He is admitted with an acute exacerbation of COPD. His baseline ABGs drawn in the clinic 2 weeks ago showed: pH, 7.36; PaCO2, 55 mm Hg; PaO2, 69 mm Hg; bicarbonate, 30 mEq/L; SaO2, 92%. In the critical care unit, Mr. R. has coarse crackles in his left lower lung base and a mild expiratory wheeze bilaterally. His cough is productive of thick yellow sputum. His skin turgor is poor; he is febrile, tachycardic, and tachypneic. Currently, Mr. R’s ABGs while receiving O2 at 2 L/min via a nasal cannula are: pH, 7.32; PaCO2, 64 mm Hg; PaO2, 50 mm Hg; bicarbonate, 30 mEq/L; SaO2, 86%. a. What is your interpretation of Mr. R’s baseline ABGs from the clinic? b. What is the probable cause of Mr. R’s COPD exacerbation, and what treatment is indicated at this time? c. What ABG changes would indicate that Mr. R’s respiratory status is deteriorating? 2. Ms. T. is a 41-year-old woman admitted to the critical care unit and mechanically ventilated for acute asthma. She was extubated yesterday and will be transferred out of the critical care unit tomorrow. What are the important points you must cover in your teaching with Ms. T.? 3. Mr. B. has just been intubated for ARF. Currently, he is agitated and very restless. What risks are associated with Mr. B’s agitation? What nursing actions are indicated in this situation? 4. Mr. C., age 27 years, was hospitalized 3 days ago after fracturing his femur in a snow-skiing accident. He has just been admitted to the critical care unit with a PE and is orally intubated and receiv­ing mechanical ventilation. What actions would you take to decrease Mr. C’s risk of developing VAP?

Answer 1

1.The rhythm is interpreted as : Third degree AV block ( complete heart block)

2.Signs and symptoms can be:Dizziness, chest pain, fatigue, shortness of breath, confusion, palpitation.

3.Initial management of patient is as follows:

Atropine is used if there is narrow qrs in ecg. It acts by reducing vagal stimulation.

Epinephrine or dopamine can be used.

Emergency electrical transcutaneus pacing can be done.

4.For this condition permanent treatment is: Permanent pacemaker or Implantable cardioverter defibrillator.