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Asked by CaptainDiscoveryTapir17
Subjective History Molly believes her condition has gotten worse over the past 2 weeks. Over the past week she has not been feeling well and notices she has gained a few pounds since weighing herself a week ago. She cannot go a few feet without getting short of breath. She speaks 2 to 3 word sentences before taking a breath. She continues to smoke even when she does not feel well. She also reveals that she sleeps in a recliner chair as she cannot sleep lying flat. She is concerned that she has lung cancer like her mother.

 

Objective Data

General Appearance: Molly is sitting in bed at 90 degrees and appears ill and malnourished. She is leaning forward on the bedside table to breathe and is visibly anxious. 

 

Temp: 37°C (97.8°F)

BP: 150/92

HR: 128

RR: 36

Sp02: 88% 

 

RESP: Lungs are clear in the upper lobes but crackles halfway up bilaterally. She has labored breathing with tripoding stance. Slight intercostal retractions noted.

CARDIAC: Mucous membranes are pink. Capillary refill is >3 seconds. Apical HR tachycardiac but regular. Peripheral pulses palpable x4 +1 thready. Ankles and feet are +3 edema BL.

NEURO: GCS 15. Alert and oriented x4. Reports anxiety and agitation. PERRLA.

GI: Abdomen rounded, soft and non-tender. NABS x 4. Last BM 2 days ago.

GU: Voids painlessly and without hesitation. Concentrated, yellow urine. Malodorous.

Musculoskeletal: Moves all extremities without overt deficits. Grip strength equal +4. Complains of generalized weakness. Stand by assist. Ambulates without a cane or walker. Bed alarm is on and audible.

Integumentary: Skin is dry and flaky. Mucous membranes are dry and lower extremities are very dry. Rubor noted. No bruises or wounds noted.

 

 

 

 

 

What orders do you expect?

What education is essential to communicate to Molly right now?
What is important to tell the Molly about HF complications?

Which Medication orders would you anticipate?

Which medications (if ordered) should be held if HR <60 bmp?   Molly is being transferred to the CVICU for hemodynamic monitoring and continuous furosemide infusion. You prepare to call report to the ICU nurse. You review Molly most recent labs and presenting symptoms. The cardiologist is planning for aggressive diuresis treatment. Furosemide gtt is infusing at 10mg/hr and the next BMP is scheduled in 4 hours. She is placed on a humidified nasal high flow system (Airvo) at 50 L and 50% FiO2 to deliver respiratory support.  She has vital signs Q15 minutes. Molly has a 18 g left forearm IV catheter. Her sodium, potassium, troponin, and BNP levels are abnormal. She is lethargic but oriented.   Now-- Considering Molly history, what information is important to include in hand off to the next oncoming shift?    The following nursing interventions were implemented.    What interventions could be implemented to help reduce edema?    How will you keep Molly safe from complications?    What instructions will be included in her discharge?     SCIENCE HEALTH SCIENCE NURSING NUR 601

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