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Nursing - Acute Pulmonary Oedema - Case Study Analysis Assignment Help
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Internal Code: 1ABGGH
PR: 150 bpm (regular)
RR: 32 per minute
BP: 90/70 mmHg
SpO2: 92% on room air (poor trace)
Mrs X is looking unwell and is cool to touch. You also notice that her breathing appears laboured, so you auscultate her anterior chest and note low pitched bubbling, moist sounds that persist from early inspiration through early expiration and a moist cough. S1 and S2 heart sounds are present but you think there may be an additional heart sound.
As you begin charting these observations you note that she meets deterioration criteria, you notify the nurse in charge and dial 444 to escalate a MET call. When the MET team arrive, the medical officer makes a differential diagnosis of Acute Pulmonary Oedema and requests the following tests;
CXR, ABG, FBE and U&E
Results of these tests are as follows:
CXR: enlarged heart, interstitial and alveolar oedema
ABG: pH 7.29, pCO2 45mmHg, pO2 60mmHg, SaO2 90%, HCO3 16, BE -5, Lactate 4.0 mmol/L
FBE: pending
U&E: Sodium 153meq/L, Potassium 5.5meq/L, Creatinine 250umol/L, Urea 15mmol/L, Calcium 2.2mmol/L Magnesium 0.6mmol/L, Phosphate 0.7 mmol/L, AST 55 U/L, ALT 76 U/L, ALP 120 U/L, Albumin 28 g/L
Pathophysiology
Nursing Case Study Analysis Assignment Help
Assignment Task: Mrs X is a 49-year-old female. Mrs X is married with 6 children and 5 grandchildren who all live together in rental accommodation rural village. Mrs X was BIBAA (brought in by air ambulance) at 0600hrs from the local hospital near her village with chest pain, rapid heartbeat and increasing shortness of breath for investigation. Mrs X has a past medical history of type two diabetes mellitus, hypertension and rheumatic fever as a child. She has been prescribed metformin, glibeclamide, perindopril, furosemide, acetylsalicylic acid, atorvastatin and nicotine patches as well as an activity and weight loss regime by her Doctor, however she is non-compliant. Mrs X has no allergies, currently smokes 20 cigarettes per day and drinks 3-6 beers/day. Over the last few months Mrs X has been experiencing increasing shortness of breath and marked swelling of the ankles over the last (3) three weeks. She feels very weak and tired most of the time and has recently been waking up with shortness of breath requiring several pillows to sleep. Mrs X presented to the local Hospital yesterday afternoon as her children felt she didn’t look well and her appetite has diminished. On presentation she was pale and clammy with a one-hour history of chest pain and palpitations. She was found to be in rapid atrial flutter and was treated with digoxin and electrolyte replacement. Mrs X heart rate normalised and the chest pain was alleviated however it was felt she required further investigation, so she was transferred to the city Hospital in by Air ambulance. You arrive at 0700hrs for the morning shift on the cardiology ward and receive Mrs X into your care. You receive an ISBAR handover from the night staff and commence your primary and secondary assessment of Mrs X. During your assessment Mrs X complains of a fast thumping sensation in the chest. You check the monitor to see the rhythm below and check her vital signs to find; GCS: 15 (E4, V5, M6) but distressed and anxious
PR: 150 bpm (regular)
RR: 32 per minute
BP: 90/70 mmHg
SpO2: 92% on room air (poor trace)
Mrs X is looking unwell and is cool to touch. You also notice that her breathing appears laboured, so you auscultate her anterior chest and note low pitched bubbling, moist sounds that persist from early inspiration through early expiration and a moist cough. S1 and S2 heart sounds are present but you think there may be an additional heart sound.
As you begin charting these observations you note that she meets deterioration criteria, you notify the nurse in charge and dial 444 to escalate a MET call. When the MET team arrive, the medical officer makes a differential diagnosis of Acute Pulmonary Oedema and requests the following tests;
CXR, ABG, FBE and U&E
Results of these tests are as follows:
CXR: enlarged heart, interstitial and alveolar oedema
ABG: pH 7.29, pCO2 45mmHg, pO2 60mmHg, SaO2 90%, HCO3 16, BE -5, Lactate 4.0 mmol/L
FBE: pending
U&E: Sodium 153meq/L, Potassium 5.5meq/L, Creatinine 250umol/L, Urea 15mmol/L, Calcium 2.2mmol/L Magnesium 0.6mmol/L, Phosphate 0.7 mmol/L, AST 55 U/L, ALT 76 U/L, ALP 120 U/L, Albumin 28 g/L
Pathophysiology
- Mrs X appears to be decompensating and is displaying signs of shock. What type of shock is she experiencing? Provide a scientific rationale for your answer.
- Mrs X presents with several classical signs and symptoms of heart failure. Select two (2) of these classical signs and symptoms and discuss the underlying pathophysiological changes underpinning the potential disease process supported by preliminary diagnoses and preliminary test results. Be sure to relate your answer to the case study.
- The medical officer has ordered a few investigations. Identify what other investigations would be useful and then select two (2) investigations and provide a scientific rationale and justification for the investigations selected. In addition, describe the investigative findings that would support a diagnosis of heart failure in Mrs X.
- Mrs X appears to have some renal impairment. Identify one (1) medication and explain the rationale for this medication. Describe the mechanism of action, adverse effect profile and outline any potential for drug-drug and/or drug-patient interaction with a focus on your patient and her kidney function.
- Acute pulmonary oedema is a medical emergency which requires immediate management. The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. Discuss one (1) pharmacological intervention that will be implemented in the management of Mrs X acute pulmonary oedema (oxygen therapy is not to be discussed). Provide a scientific rationale for the selected intervention and discuss the therapeutic benefit of the pharmacological treatment selected.
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