NURS 1410 Cardiac Clinical Reasoning: Assisting a patient with cardiovascular conditions
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Assign3v10Powerpoint2.pptxNURS 1410 Cardiac Clinical Reasoning: Assisting a patient with cardiovascular conditions
Mr. Hart is admitted. Review the patient’s chart and the nurse’s notes.
Go to patient’s room and see the nurse’s notes
Patient’s Chart
Patient’s Chart (click on what you want to review in the patient’s chart.)
Vital Signs
Patient History
Diagnostic Tests
Healthcare Provider’s Orders
MAR
Patient History
Patient’s Chart
Main
Mr. Hart, 60 years old, was diagnosed with hypertension and CAD three years ago after experiencing a left anterior MI. Two years ago, his condition worsened, and he was diagnosed in early-stage heart failure. Today, he comes to the clinic concerned that is experiencing episodes of chest tightness and a rapid heartbeat on exertion, has developed a persistent cough, and is increasingly fatigued with occasional dizziness. He reports that he is noticing shortness of breath on exertion with some chest discomfort and is becoming increasingly SOB even at rest. He has had to sleep with 3 pillows to keep from becoming SOB at night the last 2 weeks. He reports difficulty getting his shoes on the last month because of increased swelling around his ankles. He weighs himself once a week and today his weight has increased from 255 lbs. to 264 lbs. over the last 7 days. He admits that he sometimes forgets to take his medications every day. The clinic healthcare provider recognizes that Mr. Hart needs acute inpatient care and coordinates a direct admission to the hospital.
Past Medical History: Hypertension, Hyperlipidemia, CAD, MI three years ago with secondary chronic heart failure
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Diagnostic Tests:
Main
Patient’s Chart
| Lab | Today | Past |
| BNP | 475 | 300 |
| Troponins | Negative | |
| Cholesterol | 210 | 260 |
| PCR for Covid-19 | Negative | |
| Potassium | 3.6 | 3.9 |
Chest x-ray: bilateral diffuse infiltrates consistent with pulmonary edema.
Echocardiogram:
Current ejection fraction is 40% with the past ejection fraction at 49%
Electrocardiogram:
| Vital signs | Temp | HR | RR | Lung Sounds | BP | O2 Saturation |
| 0900 | 98.6 F (oral) | 110 – irregular, bounding | 28, regular, labored | Crackles both lower lobes; cough noted | 148/94 | 91% on 3L Oxygen per nasal cannula |
Main
Patient’s Chart
Main
Patient’s Chart
Health Care Provider Orders/ Prescriptions:
Place on pulse oximeter monitoring
Oxygen at 3 liters/minute per nasal cannula
Strict intake and output, daily weights with fluid restriction to 1800 mL PO daily
Apply anti-embolism stockings
Diet: Sodium-restricted, potassium-modified, low-fat, low cholesterol
Lab: Troponins, Cholesterol, BNP, Potassium level, Covid-19 PCR
Tests: Chest x-ray, EKG, Echocardiogram
Consult with Cardiac Electrophysiology for possible cardioversion
Furosemide 60 mg one-time oral dose now (STAT)
Hold dose today only eplerenone 25 mg
Begin TODAY warfarin 3 mg. PO daily
Begin TODAY digoxin 0.125 mg PO daily
Continue home meds
| Medication | 0700-1500 | 1500-2300 | 2300-0700 |
| simvastatin | 0800 20 mg po | ||
| sacubitril 49mg/valsartan 51 mg | 0800 | 2000 | |
| acetylsalicylic acid | 1300 81 mg po daily | ||
| eplerenone | HOLD TODAY 25 mg po | ||
| furosemide | 1100 60 mg one time oral dose STAT | ||
| digoxin Begin TODAY | 0.125 po | ||
| warfarin Begin TODAY | 1100 3 mg po | ||
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Patient’s Chart
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Neuro
Click on the buttons below to see the nurse’s notes.
Cardiac/
Respiratory
GI /
GU
General
Click on the buttons below to see the nurse’s notes.
Anxious; Alert & Oriented
Client states that he feels light-headed and a little dizzy when standing. No blurred vision.
Cardiac/
Respiratory
GI /
GU
General
Click on the buttons below to see the nurse’s notes.
Cardiac – Skin pale, cool to the touch, Pulse bounding and noted to be irregular, 2-3+ pitting edema lower extremities. No JVD noted. Capillary refill 2 seconds.
Resp – Coarse crackles scattered throughout both lung fields. Labored respiratory effort. Patient sitting upright. Coughing noted. Client states that he feels short of breath. Oxygen saturation: 91% on 3 l/min oxygen.
Neuro
GI /
GU
General
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GI – Active bowel sounds in all 4 quadrants. Abdomen soft/non-tender. No appetite. Reports that he had a bowel movement yesterday.
GU – Voiding without difficulty, urine clear/yellow. Reports getting up at night to urinate.
Neuro
Cardiac/
Respiratory
General
Click on the buttons below to see the nurse’s notes.
Other - Denies pain but expresses that his chest feels “tight”. Slight headache. Skin integrity intact. Appears anxious, restless, and reports dizziness.
First Quetion
Patient’s Chart
Main
Cardiac/
Respiratory
Neuro
GI /
GU
