Jimmy G., a 69-year-old white man, presents with dyspnea on exertion and since his last visit 9 months ago, has gained weight and lost his appetite.
Critical Thinking Questions:
1. What additional subjective data do you think the patient will share?
2. What additional objective data will you assess for?
3. What National Guidelines are appropriate to consider?
The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed.
4. What tests will you order?(depending on availability)
Most likely I would send this individual to the Emergency Department ASAP!
But First I would assess O2 Saturation and get a 12 lead ECG.
5. Will you be looking for a consult?
Yes, I would be looking for a Cardiologist and Pulmonology consult.
6. What are the medical diagnoses?
7. What is your plan of care?
Oxygen. Immediately assess the oxygen saturation and put oxygen on the patient. Oxygen for the patient can range up to 10–15 L/min via Hudson type mask and reservoir bag even for a patient with known COPD because the risk of hyperoxic hypercapnia as oxygenation is the priority. You must monitor the patients conscious state, respiratory rate and oxygenation. I would also plan for home O2 2L nasal cannula to and to be assessed periodically with breaks so that the body does not become dependent on it.
Diuretics. Such as furosemide (Lasix), will decrease the pressure caused by excess fluid in the heart and lungs. May also use spironolactone as an add on if symptom control is inadequate.
Blood pressure medications. Some blood pressure medications will ease the pressure going into (preload reducers) or out of (afterload reducers) the heart. Nitroglycerin is a preload reducer that helps decrease the pressure going into the heart. Medications such as nitroprusside
(Nitropress) are afterload reducers that dilate the blood vessels and take a pressure load off the heart's left ventricle.
Morphine (MS Contin). Relieves shortness of breathe and anxiety.
Anticoagulant. Low Molecular Weight Heparin for DVT prevention
8. What additional patient teaching is needed?
Lifestyle modifications includes:
Dains, J. E., Baumann, L. C., & Scheibel, P. (2020). Advanced Health Assessment and Clinical Diagnosis in Primary Care (6th ed.). St. Louis, Missouri: Elsevier.
Purvey, M., & Allen, G. (2017). Managing acute pulmonary edema. Australian Prescriber, 40(2), 59–63. https://doi.org/10.18773/austprescr.2017.013
Stern, S. D. C., Cifu, A. S., & Altkorn, D. (2015). Symptom to Diagnosis An Evidence-Based Guide (3rd ed.). New York City, NY: McGraw-Hill.
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (4th ed.). Philadelphia, PA: F.A. Davis Company.
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