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

This question has been answered.

Get Answer