CHF nursing situation
Patient is a 82 year old male who presented to the ED at 5am for shortness of breath worsening over the past day, PMH includes CHF, HTN, hyperlipidemia, CAD s/p cardiac stents in 2014, DM, osteoarthrtis, BPH, depression, CKD st 3
Admitted for CHF exacerbation, pneumonia, acute on chronic renal disease
You receive him on the floor at 11:30 am, he appears to be alert and oriented, but lethargic, states he hasn't taken any home meds yet today, has not eaten yet either. Lives at ALF, uses walker
In the ED, he received IV furosemide 40mg, 650mg Tylenol, 500mg IV levofloxacin and an albuterol/ipratropium nebulizer treatment
Selected labs, diagnostics, and orders
WBC
18.2
Hgb
10.4
K (potassium)
3.1
creatinine
4.1
blood glucose
308
BNP
8023
Urine - blood
large
Urine - leukocytes
+3
Urine - culture
pending
COVID 19 PCR - negative
chest x-ray
bilateral infiltrates, pleural effusions
sputum sample to be collected
normal sinus rhythm on tele monitor
vital signs
170/64, P55, R23, O2 90% room air, temp 100.4, ht 178cm, wt 90kg
Diet: cardiac, 1800 ADA, 1 liter free water restriction
Activity: as tolerated
Strict I&O
home medications - have all been profiled to MAR
Hospital meds
metoprolol
25mg
BID
albuterol/ipratropium
Q6hrs
amlodipine
5mg
QAM
furosemide IV
40mg
once 6pm
lisinopril
20mg
QAM
levafloxacin IV
500mg
Q24hrs
atorvastatin
40mg
QPM
tylenol
650mg
Q6hrs PRN
tamsulosin
0.4mg
QPM
IV potassium 10 meq
x3
clopidogrel
75mg
QAM
aspirin
81mg
QAM
escitalopram
10mg
QAM
metformin
1000mg
BID
tramadol
50mg
Q8hrs PRN
gabapentin
200mg
BID
temazepam
7.5mg
QHS PRN
Consults pending - cardiology, ID, nephrology
Personal history
former smoker, quit 35 years ago
does not drink alcohol
did not get flu shot this year
Discussion
What would you expect breath sounds may be like (document this in EHR)?
What would you expect skin condition/lower extremities to be like (document this in EHR)?
What interventions would you perform (safety, patient care, medication, etc)
What else are you concerned about when assessing?
Think about questions to ask the patient so you have a better report to give to consulting providers if they call
What does each medication do? Would you hold any?
Sample Solution
se a conflict (Frowe (2011), Page 50). Right off the bat, Vittola examines one of the noble motivations of war, in particular, is when damage is caused however he causes notice the damage doesn't prompt conflict, it relies upon the degree or proportionality, one more condition to jus promotion bellum (Begby et al (2006b), Page 314). Frowe, nonetheless, contends the possibility of "worthwhile motivation" in view of "Power" which alludes to the assurance of political and regional privileges, alongside basic freedoms. In contemporary view, this view is more convoluted to reply, given the ascent of globalization. Additionally, it is challenging to gauge proportionality, especially in war, on the grounds that not just that there is an epistemic issue in ascertaining, yet again the present world has created (Frowe (2011), Page 54-6). Besides, Vittola contends war is fundamental, not just for protective purposes, 'since it is legitimate to oppose force with force,' yet additionally to battle against the vile, a hostile conflict, countries which are not rebuffed for acting unjustifiably towards its own kin or have shamefully taken land from the home country (Begby et al (2006b), Page 310&313); to "show its foes a thing or two," yet essentially to accomplish the point of war. This approves Aristotle's contention: 'there should be battle for harmony (Aristotle (1996), Page 187). Notwithstanding, Frowe contends "self-protection" has a majority of depictions, found in Chapter 1, demonstrating the way that self-preservation can't necessarily legitimize one's activities. Significantly more dangerous, is the situation of self-preservation in war, where two clashing perspectives are laid out: The Collectivists, an entirely different hypothesis and the Individualists, the continuation of the homegrown hypothesis of self-protection (Frowe (2011), Page 9& 29-34). All the more significantly, Frowe discredits Vittola's view on retribution on the grounds that first and foremost it enables the punisher's position, yet additionally the present world forestalls this activity between nations through lawful bodies like the UN, since we have modernized into a moderately serene society (Frowe (2011), Page 80-1). Above all, Frowe further disproves Vittola through his case that 'right aim can't be blamed so as to take up arms in light of expected wrong,' proposing we can't simply hurt another on the grounds that they have accomplished something treacherous. Different variables should be thought of, for instance, Proportionality. Thirdly, Vittola contends that war ought to be stayed away from (Begby et al (2006b), Page 332) and that we ought to continue conditions carefully. This is upheld by the "final retreat" position in Frowe, where war ought not be allowed except if all actions to look for tact falls flat (Frowe (2011), Page 62). This implies war ought not be announced until one party must choose the option to proclaim battle, to pr