SOLVED

As a Nurse, Rank the three patient health issues (Impaired gas exchange, the potential for alcohol withdrawal and Riak of developing DVT) in order of priority. Provide a rationale for the order of the rankings. The rationale must be supported with current literature.
This is the case study:
Cardiac case scenario
Patient name: Brendan Walsh
Handover report to Ward 3B Cardiology
Date of handover report: 15 th September 2021 at 10.00 hours
MRN: 755 845 DOB: 15.04.1965
Weight: 90kg
Height: 175cm
BMI: 29.4kg/m2 (overweight)
Introduction
Brendan Walsh a 56-year-old male presented to the Emergency department early this morning complaining of chest tightness and increasing shortness of breath. The patient’s partner has accompanied him to the hospital.
Situation
On examination in the Emergency department upon arrival at 07:00hrs, Brendan initially presented with chest tightness and shortness of breath, feeling occasionally lightheaded, tachycardia, hypertension and swelling in his ankles to his knees. He is alert and orientated. An ECG, CXR and Echocardiogram were performed. ECG shows left ventricular hypertrophy with no ST changes. Echocardiogram shows worsening heart failure and reduced ejection fraction with evidence of pulmonary hypertension. CXR shows the heart is enlarged and bilateral lower lobe congestion. Oxygen was applied as the Sp02 was 93% on RA, currently 95% on 2L via NP.
Background
Brendan has a medical history of Idiopathic (non-ischemic) Dilated Cardiomyopathy NYHA class II diagnosed two years ago, Hypertension managed with Metoprolol, Type II Diabetes Mellitus (Diet controlled), ETOH (Ethyl alcohol) usually drinks 4 – 5 bottles of wine per week and smokes one packet of cigarettes per week. Brendan lives with his partner and has one son who lives interstate. Brendan and his partner manage a wine vineyard on the south coast.
Assessment
Observations were taken on arrival to the Emergency department:
BP: 160/90 mmHg
HR: 110 beats per minute
SpO2: 93% R/A; 95% on 2L NP
RR: 28 breaths per minute
Temp: 36.8 OC (oral)
Glasgo Coma Scale (GCS): 15/15 (Eye = 4, Verbal = 5, Motor = 6)
Pain score: 6/10
BGL: 9.6 mmol/L
Recommendations
Formal Bloods including: Full Blood Count, Urea, Electrolytes, Creatinine (UEC’s)
Arterial Blood Gas
Monitor GCS and vital observations
Alcohol Withdrawal Scale (AWS)
Administration of Diuretics and Beta blocker medications as charted
Fluid restriction of 1.5 Litres per day and strict fluid balance
Daily weight

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