Nursing Case Study Case Studies

Background: Mr. A is a 65-year-old male admitted on 3/7 for pacemaker revision and video-assisted thoracic surgery (VATS) epicardial lead placement. He is currently post op day 6. Mr. A has a history of viral cardiomyopathy which was diagnosed 3/2016. His ejection fraction is estimated to be 30%. Following the removal of a cardiac resynchronization therapy (CRT) device in 11/2017, Mr. A was required to wear a LifeVest. In the past, Mr. A has undergone three implantable cardioverter defibrillator (ICD) placements all of which became infected and failed. Mr. A also has a history of chronic kidney disease as well as chronic obstructive pulmonary disease. At home, Mr. A is oxygen dependent and uses 4L at night only. The primary purpose
A was experiencing a lot of anxiety and some confusion, which exacerbated his anxiety. Following surgery, Mr. A's renal function worsened causing fluid volume overload. His confusion and myoclonic jerks were concerning for uremia. Throughout the day, Mr. A's vital signs were stable: HR 70 bpm, BP 120/60, temperature 98.6 F, RR 21, O2 saturation 96% at rest on 3L of O2. Other than anxiety, Mr. A's other major complaint was coccyx pain relating to a stage II pressure ulcer, which was being managed with wound care and frequent turning. A pressure redistribution bed had been ordered and expected to come later in the day. Mr. A did not have any visitors and reported that his wife was going to come the following day. He stated that he was "pretty lonely" and "sick" of being in the hospital and wished he could go home and be with his
Written close to the development of wearable defibrillator technology, Schott explains how the device is designed to provide continuous monitoring and has the ability to defibrillate patients who are at increased risk of sudden cardiac death. The article explains the basics of how the wearable defibrillator works. Specifically, if the heart rate progresses into a lethal dysrhythmia, first the monitor will alarm, then the device will deliver a shock to treat the dysrhythmia if the alarm is not responded to or due to loss of consciousness (Schott, 2002). However, during an alarm sequence period, any restoration of a normal heart rhythm will prevent the device from delivering an electrical shock (Schott, 2002). It is also important to note that the device also stores the electrocardiogram during this time, which aids health care providers in understanding what occurred during the dysrhythmia (Schott, 2002). Though Schott lists patients who have had an infarct and those awaiting transplantation as the primary wearers of wearable defibrillators, Mr. A's severe cardiomyopathy also puts him at risk for sudden death which indicates his use of the defibrillator. Benefits of the device include using the wearing defibrillator to allow individuals to leave the health care institution with protection from