Page 175 - Critical Care Nursing Demystified

160 CRITICAL CARE NURSING DeMYSTIFIED

ANSWERS

CASE STUDY

1. HTN, MI, gender, and race.
2. Increased urination, persistent cough, 20-lb weight gain in 1 week, extreme fatigue and
SOB with exertion, feet and ankle edema.
3. The BNP is the most definite, especially if it is greater than 400 pg/mL. Chest x-rays can
show pulmonary edema but not the cause. ABGs can indicate respiratory alkalosis in
the early stages and acidosis in the later stages. A decreased SaO can confirm a drop
2
in oxygenation, but ABGs are more specific. An ECG can show nonspecific ST segment
elevation or MI changes (which can cause HF).
4. He has signs and symptoms of biventricular failure. His SOB and persistent cough indi-
cate left (lung) involvement but his edema indicates right (peripheral).
5. Decreased CO RT effects of high systemic pressure, pulmonary pressures AMB greater
than BP, cough, SOB, and peripheral edema. Ineffective gas exchange RT increased pul-
monary capillary pressure AMB cough and SOB.
6.

Symptoms/Signs Interventions
Nocturia Fluid restrictions especially after 6 p.m. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Weight gain Diuretic therapy
Decrease intake of salt-laden foods
SOB Elevate the HOB
Persistent cough Rest on pillows on the over-the-bed table
Oxygen
Diuretic therapy
High BP Antihypertensive medications like ACE inhibitors or ARBs,
beta-blockers, calcium channel blockers
Stress management therapy
Weight reduction
Peripheral Antihypertensive medications like ACE inhibitors or ARBs,
edema beta-blockers, calcium channel blockers
Diuretic therapy
Stress management therapy
Weight reduction
Low sodium diet
Elevate legs above the heart
Periodic rest periods throughout the day