Question

A 74-year-old woman was admitted to the hospital with heart failure. She had been growing progressively weaker and also had ankle edema, dyspnea on exertion, and three pillow orthopnea. On admission, she is severely dyspneic and can answer questions only with one-word phrases. She is diaphoretic, with a respiratory rate of 28/min, heart rate of 132 beats/min, and BP 98/70. Her oral temperature is 36.7 C and her SaO2 89%. She is extremely anxious. The nurse applies immediately oxygen at 2 L via NC as per unit protocol. The physician orders: Insert PIV then start Dobutamine 3 mcg/kg/hr Furosemide 40 mg IV stat, Digoxin 0.5 mg orally stat, then 0.125 mg every 6 h for three does with ECG before doses 3 and 4; morphine 2 mg IV stat, and then 2 mg IV every 1-2 h prn, increase O2 to 4 L/min. Schedule patient for an echocardiogram, no added salt diet, weigh patient daily and record: Strict I&O. Answer the questions below and give rationales for your answer. 3. Based on the assessment, identify problems for this patient.

Answer 1

Answer: According to the case study, the patient is suffering from heart failure which leads to edema in ankle where as she also have increased heart rate which is mainly due to heart failure. Increased heart rate is beyond the normal heart beat. Patient is suffering from hypotension which shows that patient is in little unconscious state. She is also suferrisu from orthopnea i.e. she is unable to breathe while laying down so sheet needs support of pillow to be elevated so that she can breathe properly.