Week4 Case-Study: Care of Patients

Week4 Case-Study: Care of Patients
Week4 Case-Study: Care of Patients
Week4 Case-Study: Care of Patients
Week 4 discussion Discussion Part I: Assessment and Care of Patients With Cardiovascular Conditions Many cardiac disorders such as myocardial infarctions are a common problem in the acute care setting. Thus it is essential for you, as the advanced practice nurse caring for acute patients, to identify potential signs and symptoms of complications. Although some cardiac disorders require outpatient treatment and management, other procedures such as CABGs or valve replacements are more common and frequently require major interventions. In your role with acute cardiac patients, you must evaluate symptoms and determine how to treat patients. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies. Case Study 1: Tom is 56-year-old African American male who presented to the ED with chest pain radiating to his back. The pain has been continuous for 1 hour. The patient complains of shortness of breath. The pain has not been relieved with rest. The patient’s vitals are: 99.1-98-18-198/110. The patient’s cardiac enzymes are negative. Labs results are as follows: Na 134 K 4.1 Cr 1.8 BUN 42 Glucose 248 WBC 13.1 Hbg 14.1 Hct 44.2 Plt 236 EKG sinus rhythm no ekg changes Case Study 2: Liz is a 79-year-old female with a history of aortic stenosis and hypertension. The patient underwent elective aortic valve replacement yesterday. This AM during rounds, the patient is sitting up in the chair. Vital signs: 99.4-54-20-85/50. Pa 29/13, CVP10. Urine output 20 ml/hr for the last 3 hours. Cardiac output 3.9, cardiac index 1.8. Patient’s preop ef was 50%. Labs are as follows: K 4.0 Cr 1.5 BUN 42 Hgb 9.8 Hct 29.1 Plt 138 Postoperative chest X-ray normal Case Study 3: Arvid is a 69-year-old male you are seeing in CCU 1 hour after he had a CABG × 4. The patient is intubated. VS: 97.1-78-14-90/50. PA 30/13, CVP 12. ABG 7.21-49-98-19.6-99%- -6 base deficit. Mixed venous O2 sat 68. Hgb 10.2, Hct 32.1. The patient is sedated. Vent settings FiO2 50%, IMV 12, PEEP 5, tidal volume 550. To prepare: Review and select 1 of the 3 case studies provided. Analyze the patient information. Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments. Consider strategies for educating patients and families on the treatment and management of the cardiac disorder. Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the cardiac disorder. Read a selection of your colleagues’ responses. Respond on or before Day 6 to at least two of your colleagues on 2 different days in both of the ways listed below. Respond to colleagues who selected different case studies from yours. Describe how a patient factor such as age, gender, ethnicity or culture might affect the diagnosis, management, and follow-up care of patients with the cardiac disorders your colleagues discussed. Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.? Discussion Part II: Pharmacology To prepare: Read the following article to enhance your knowledge of commonly prescribed medications: Kalil, A., & Bailey, K. L. (2014, October 20). Septic shock medication. Retrieved from http://emedicine.medscape.com/article/168402-medication All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage. All of the following groups of medications are commonly prescribed in the acute care setting. This Discussion will focus on CABG patients. Choose one of the topics below to discuss in terms of management of a post-CABG patient. Focus your discussion on the hospital or ICU setting and IV usage. Amicar Epinephrine Vasopressin Nitroglycerin Cardene Insulin drip Dopamine Dobutamine Norepinephrine Phenylephrine Note: When sharing your initial post, select a drug that has not yet been discussed. If all drugs have been discussed, then you may select that drug again. For this Discussion, address 1 of the following options. Post by Day 3: Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose. Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication? Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

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