Multisystem Case Scenario
Section Instructor: Josanne Christian
Florida Hospital College of Health Sciences
July 22, 2010
Mr. Jones presents to the ED with a complex combination of symptoms. Clinicians must swiftly evaluate and treat his conditions. Air way protection as well as hemodynamic stability is extremely important. Mr. Jones’s case requires rapid intervention as his condition has been worsening for the past week. Pathology and treatment options are explored to enrich the educational component. Emotional support and long term treatment options must be discussed with Mr. Jones in order to meet his needs.
Multisystem Case Study
Heart failure (HF) is approaching epidemic levels. The statistics are staggering. Approximately 5 million people are currently diagnosed with HF in the U.S. with 550,000 being diagnosed yearly; health care cost is approaching an exorbitant $28 billion annually (Rasmusson & Renlund, 2006). Chronic obstructive pulmonary disease (COPD) is presently the fourth leading cause of death world wide (Kara, 2005). As nurses it is imperative that we educate patients and their family members on risk reduction, identifying early signs and symptoms and latest treatment advances made towards controlling chronic conditions such as HF and COPD. Scenario
Mr. Jones 68 y/o male arrives at the Emergency Department (ED) with complaints of increased dyspnea with exertion for the past three days, weight gain of 6 lbs in the last week, swelling to legs and feet and a noticeable decrease in urination. Mr. Jones does have a history of congestive heart failure (CHF), emphysema, hypertension, Type II diabetes and rheumatic fever as a child. The patient admits to a long history of cigarette smoking having decreased his smoking to ½ a pack daily since being diagnosed with emphysema five years ago. On initial assessment Mr. Jones appeared stated age but fatigued, was alert and oriented to time, place and situation, pupils 3 equal and reactive. Blood pressure 156/94, heart rate 102, rhythm sinus tachycardia, heart tones includes S3 gallop, denies chest pain and peripheral pulses were palpable with weak bilateral post-tibial and dorsalis pedis. Lung sounds were clear upper lobes with crackles in bilateral lower lobes, patient is dyspnic on exertion. Pulse oximeter 88% on room air, oxygen was applied at 2 l/m via nasal cannula which improved oxygen saturation to 94%. Abdomen obese had positive bowel sounds in all four quadrants, non-tender, non-distended, last bowel movement was yesterday morning. Mr. Jones reports a decrease in urinary frequency as well as amount, recalls urinating very small amount twice daily in the past two days. Skin was intact, has 3 + bilateral lower extremity edema. Mr. Jones reports the following medication regime: Altace 5mg PO twice daily, Toprol XL 25mg PO daily, Aldactone 25mg PO daily, Advair Diskus 250/50 mcg inhaler twice daily and Spiriva 1 cap inhaled daily. Mr. Jones reports that he has not taken his medications in the past 7 days because he did not have the money to purchase them. The ED physician orders the following tests: complete blood count, complete metabolic profile, thyroid level, lipid profile, homocysteine levels, Troponin I every 8 hrs x 3, BNP, HGBA1C, ABG, EKG, CXR, 2D Echo and a Cardiology consult. Order for Lasix 40 mg IV every 8 hrs with the first dose to be given stat was written. A urethral catheter was inserted in order to maintain strict I&O and 1500 ml fluid restriction was ordered. Chronic Disease Review: Congestive Heart Failure
According to Brashers heart failure affects 10% of the population over the age of 65 and is the most frequent reason for hospital admission in this age group (2008). HF encompasses several types of cardiac malfunction which results in insufficient blood supply to the body’s tissues and organs. The most common cause of HF results...