John Smith, 68 year-old male, is diagnosed with heart failure. He is also an ast
ID: 85836 • Letter: J
Question
John Smith, 68 year-old male, is diagnosed with heart failure. He is also an asthmatic and diabetic. He is usually on 2 liters of oxygen, but is now requiring 6 liters of oxygen by nasal cannula. John experiencing significant dyspnea upon exertion. You are caring for him and are responsible for interpreting his medication orders and subsequent nursing implications. Here are John's current vitals and medications: Vitals: HR: 58 BP: 168/90 RR: 24 Spo2: 90%, 6 Liters per Nasal Cannula Temp: 98.9 degrees F Medications: Metoprolol 25mg PO BID Lasix 40mg PO BID Lisinopril 20mg PO BID Prednisone 10mg PO Daily 1. What should your detailed nursing assessment consist of at this time? 2. What laboratory results will you look for? Why? 3. How will you know that the Lasix has been effective? 4. What medication(s) may be problematic concerning the patient's diabetes? 5. The patient's creatinine is 2.5, what medications may need to be held? Why? 6. What diet should the patient be on? 7. What will you report to the physician? Why?Explanation / Answer
Heart failure is the condition in which the heart is unable to pump blood and meet the actual blood requirement of the body. Causes of heart failure include heart attack, coronary artery disease, infection of heart, heart valve problem, etc.
1. The assessment of the patient includes examination of breathing of patient since he is asthmatic the breathing should be examined more closely. The swelling of the feet and legs should be examined. The patient is diabetic so usually he will experience excessive urination, but the excess urination at the night time should be examined carefully. Since the patient requires 6 litres oxygen the physical activity of the patient should be assessed closely. The sleeping habit of the patient should also be assessed.
2. The lab tests which should be focused on are;
CBC- the reduced RBC count can indicate heart failure.
BNP(Brain Natriuretic Peptide)- The BNP level may drop when treatment for heart failure is working.
Blood glucose- The patients sugar level should be controlled because it might create some serious problems if ignored.
Lipid Panel- A lipid panel is a blood test that measures lipids—fats and fatty substances used in the body.
Renal function test- the improper functioning of kidney might cause problem in heart functioning.
Lung function test - It is also mandatory as the patient is asthmatic.
3. Lasix is used to reduce swelling and treat high blood pressure. In case of John we can evaluate the effectiveness of Lasix, if the swelling in John's body is reduced.
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