Mrs. G. is a 74 year old

Mrs. G. is a 74 year old Hispanic woman who is brought to the ER by her daughter. The patient does not speak any English. The daughter does. The daughter states Mrs. G. has been weak, restless, confused, and getting “puffy”. Upon physical exam, she has a murmur, 3+ knee down edema bilaterally, she weighs 152 pounds, she has crackles in her lungs bilaterally mid lobes down, her blood pressure is 168/88, heart rate is 108 and irregular, respirations 28, regular and shallow, Temperature 99.1 degrees F, and the rest of the physical assessment is normal. Per her daughter “her weight is up 20 pounds in the past week; she usually weighs 132 pounds.” She is 74 years old, lives alone, and does not like to cook for herself. Her diet history is unclear, but you determine from her daughter that she mostly eats canned soups, crackers, and bologna and cheese sandwiches. She drinks coffee with her meals and frequently throughout the day. She has a history of CHF, Hypertension, and takes Aspirin 81 mg PO daily, Lasix 40 mg PO daily, Lisinopril 20 mg PO daily, and Metoprolol Succinate 25 mg PO daily. Lab data: BNP 1250 – elevated BUN 30 – elevated Creatinine 2.1 – elevated Potassium 2.1 – decreased Sodium 129 – decreased Blood glucose 175 – elevated All other labs were normal. MD orders: CXR, Echocardiogram, and 12-lead ECG now Aspirin 81 mg PO daily Lasix 40 mg IV push twice per day Lisinopril 40 mg PO daily Metoprolol Succinate 25 mg PO daily Potassium 40 mg PO now and twice daily Continuous Telemetry Blood Glucose AC & HS 2 gm Sodium, Low Cholesterol Diet Activity: up with assist Complete the following: what could be the causes for the abnormalities of each? What assessments and interventions would be performed? What is the pathophysiology of Right vs. Left Heart Failure? What are the signs and symptoms of each. What kind of patient teaching regarding each diagnostic test would you give? How would the table be filled in below? Diagnostic test What it tells us Why this test was ordered for this patient Nursing Implications: include patient teaching about the test, if a consent form is needed or not, and any pre- or post- assessments required CXR Echocardiogram 12-lead ECG What would the plan of care be? What would 2 priority nursing diagnosis be? What would 2 goals be for each diagnosis? One being a Short term and the other being long term? Long term would be more for family to provide at home. What type of discharge instructions would be given? Identify the nursing orders: assessments and interventions, including patient teaching? Fill in collaborative orders column — including medications, and healthcare team members that may need to be collaborated with in order to provide the best care for the patient in relation to the specific nursing diagnosis?

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