Posted: August 15th, 2022

A 60-year-old client presents to the ED

Nursing homework Help – case sudy
Case Examine

Evaluate all of the knowledge in the following case research and reply the 5 questions beneath with three APA sources to help your work:

A 60-year-old client presents to the ED with extreme onset shortness of breath, fatigue, and up to date weight acquire of 5kg. The client experiences issue sleeping. He states, “I really feel like I’m drowning.” He experiences utilizing a number of pillows to enhance this sense with out aid. That is the client’s second hospital admission this yr for the same criticism. His previous medical historical past is critical for coronary heart failure, a 20-year pack historical past of smoking, COPD, coronary artery illness, myocardial infarction, hypertension, hyperlipidemia, diabetes mellitus, and weight problems. Previous surgical historical past is critical for cardiac catheterization with stent placement. The client’s household experiences he isn’t adherent to his medicine routine. He likes to eat quick meals and frozen dinners for many of his meals every week. He doesn’t interact in train and lives a sedentary way of life.

Remedy listing contains:

1. Lasix 20 mg by mouth twice every day

2. Metformin 500 mg by mouth twice every day

three. Nebivolol 5 mg by mouth every day

four. Aspirin 81 mg by mouth every day

5. Rosuvastatin 40 mg by mouth every day

6. Lisinopril 20 mg by mouth every day

7. Fluticasone-vilanterol 100-25 mg inhaled every day

eight. Albuterol-ipratropium inhaled each four hours as wanted

9. Digoxin 60 mg PO every day

Bodily Examination:

Preliminary bodily examination reveals temperature 98.4F, coronary heart price 128/min, respiratory price 28, BP 180/95, Top 160 cm, Weight 100 kg, BMI 39.1, oxygen saturation 90% on room air.

Alert and oriented x3, anxious, PERRLA, Cranial nerves 1-12 intact, Cardiac Assessment reveals S1, S2, and S3 coronary heart sounds, bilaterally pitting edema +2. Auscultation of the lungs revealed bibasilar pulmonary rales. There use of accent muscular tissues, nasal flaring, and extreme shortness of breath. The stomach is distended and non-tender, there’s optimistic hepatojugular reflux, JVD >4cm. All different Assessment findings have been regular. Conscious and oriented x3, uneasy, PERRLA, and apprehensive Cranial nerves 1 by means of 12 are unhurt, The cardiac examination signifies S1, S2, and S3 coronary heart sounds, as well as to bilateral pitting edema with a plus 2 score. The affected person’s lungs have been discovered to have bibasilar pulmonary rales throughout auscultation. The employment of auxiliary muscular tissues, the flare of the nostril, and a extreme lack of air are all signs. The stomach is bloated and never painful, there’s proof of optimistic hepatojugular reflux, and the JVD is bigger than four centimeters. The remaining conclusions of the analysis have been typical.

Diagnostics

EKG and chest x-ray revealed cardiomegaly, vascular engorgement, and gentle interstitial edema.

Labs: Na 128 mEq/L, Ok 5.2 mEq/L, BUN 82 g/dL, Crt 1.eight mg/dL, trop I zero.1 ng/mL , BNP 1300 pg/mL, Glu 140 g/dL.

Reply the following 5 questions. Use APA at the least three references to help your work, you should utilize the course textual content as considered one of your references. The references must be scholarly sources.

1. What are precedence NANDA nursing analysis and interventions with rationales from proof based mostly literature for this client? (Record at three analysis with 2 interventions per analysis).

Nursing Prognosis

a. Intervention with rationale

b. Intervention with rationale

Nursing Prognosis

a. Intervention with rationale

b. Intervention with rationale

2. Record at the least four indicators and signs of coronary heart failure:

a. Proper sided coronary heart failure

b. Left sided coronary heart failure

three. From the case research establish coronary heart failure signs on this client together with historical past, diagnostics, and bodily examination findings.

four. Present the rationale for every of the following therapies for coronary heart failure shoppers. Use APA references to help your work.

Oxygen administration:

Diuretics:

Inotropic drug remedy:

Vasodilator drug remedy:

Fluid restriction:

Sodium restriction:

5. What ought to a nurse embrace when planning discharge educating for a client with coronary heart failure? How can the nurse stop rehospitalization on this client?

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