CASE STUDY Nurse’s Note: 1015 – 68-year-old male client brou…
CASE STUDY Nurse’s Note: 1015 – 68-year-old male client brought to the emergency department by significant other. Client reports waking up this morning and being “unable to breathe.” The client was treated for bronchitis 3 weeks ago by their primary care provider. Client reports no pain, nausea, vomiting, or difficulty urinating. Last bowel movement was yesterday. Skin is cyanotic and client is diaphoretic. Clubbing of nail beds present. Lungs are diminished in bilateral bases. Client has a productive cough. Sputum is thick, whitish-yellow color. Pedal pulses 2+ bilaterally. Skin turgor greater than 2 seconds. Labs, chest x-ray (CXR), and arterial blood gas (ABG) obtained. History and Physical: 1015 – Hypertension, Hyperlipidemia, Hypothyroidism; Bronchitis 3 weeks ago was treated with antibiotics; Smoker for past 40 years, smokes 2 packs per day; Denies daily alcohol use. Vital Signs @ 1015 Temperature 37.1° C (98.8° F)Heart rate 100/minRespiratory rate 26/minBlood pressure 164/90 mm HgOxygen saturation 84% on room air Diagnostic Results: 1030 Lab Client Result Normal Value Range Sodium 142 mEq/L 136-145 mEq/L Potassium 4.8 mEq/L 3.5-5 mEq/L Calcium 9.5 mg/dL 7.6-10.4 mg/dL Hemoglobin 16 g/dL 14-18 g/dL Hematocrit 46% 40%-52% WBC 7000 mm³ 5000-10000 mm³ ABG: pH 7.25 7.25-7.45 PCO2 50 mmHg 35-45 mmHg HCO3 24 mEq/L 22-26 mEq/L 1045 – CXR: hyperinflation of lungs with flattened diaphragm Which of the following findings require immediate action? (Select All That Apply)
Read DetailsA patient arrives at the emergency department with crushing…
A patient arrives at the emergency department with crushing substernal chest pain that started 45 minutes ago while they were watching television. The pain is described as “pressure-like,” radiating to their left arm and jaw. They are diaphoretic, pale, and anxious. They have a past medical history of hypertension, hyperlipidemia, and type 2 diabetes. Vital Signs on Admission: BP: 150/90 mmHg HR: 110 bpm, irregular RR: 32 breaths/min SpO2: 88% on room air Current Medications: Lisinopril 10 mg daily Metformin 500 mg BID Simvastatin 20 mg daily Diagnostic Findings: ST-segment elevation noted on ECG Troponin level pending The healthcare provider orders the following: Oxygen at 2 L/min via nasal cannula Nitroglycerin sublingual, every 5 minutes PRN for chest pain Aspirin 325 mg, chewable Morphine sulfate 2 mg IV PRN for pain Metoprolol 5 mg IV Prepare for percutaneous coronary intervention (PCI) The nurse prepares to administer Metoprolol (lopressor) 5 mg IV. What is the priority assessment before giving this medication?
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