DOESN’T NEED TO ANSWER ALL S. Just as much as possible. [CASE STUDY]  You are t

DOESN’T NEED TO ANSWER ALL S. Just as much as possible. [CASE STUDY]  You are the RN working in a home care agency. You have been assigned the following case: Mr. Stern is a 62-year-old male who was recently discharged from the hospital after recovering from an MI. His first MI was when he was 58 years old. Mr. Stern was discharged on the following Medications: Digoxin .25 mg PO OD, Lasix 40 mg PO OD, KCL 20 Meq PO OD, and nitrol ointment 1 inch q6h. You have an appointment to see Mr. Stern at 9 am. Mrs. Stern, who is 58 years old, leaves for work at Macy*s at 10 am where she is a full-time employee. When arriving at the Sterns you are welcomed by Mrs. Stern. Other than putting on her shoes, Mrs. Stern appears ready to leave for work. She takes you to the den where Mr. Stern is dozing in a recliner and has the TV on. While observing Mr. Stern, you note he is pale and tachypnic at rest. Mr. Stern awakens and wants to know why Mrs. Stern is already home from work. 1) What do you suspect is causing Mr. Sterns altered mental status and pallor?  While talking Mr. Stern becomes increasingly dyspnic and starts to cough.2) What is the physiologic reason for the dyspnea and cough?  3) Do you suspect Mr. Stern is in right-sided CHF or left-sided CHF?What are some causes of left sided congestive heart failure?  You proceed with the physical assessment. Your neurologic assessment from earlier reveals Mr. Stern is oriented to person and place, though confused to time. Mr. Sterns BP is 130/70, his pulse is 110 and irregular.3) What common dysrhythmmia is present in CHF?? What lung sounds are frequently present in CHF and where are they initially heard?   While you are completing your assessment, Mrs. Stern finished getting ready for work. While putting on her shoes she states, My feet are more swollen than usual, I can hardly get my shoes on. She also tells you she has gained 4 pounds in the past 2 weeks and has noticed she has been urinating more frequently at night (nocturia).4) Is Mrs. Stern displaying symptoms of right or left-sided CHF? What are the physiologic reasons for her symptoms? What other symptoms may be present in this type of failure. What are some of the causes of this type of CHF?    Before Mrs. Stern leaves for work, you decide to review Mr. Stern’s meds with her. You ask to see the medication bottles. The Digoxin label states: Digoxin .125 mg PO OD. Mrs. Stern tells you he takes one a day like he did before he went into the hospital.5) What is your nursing diagnosis for this couple? What do you need to tell them about digoxin, including side effects?   The Lasix label states: furosemide 20 mg PO od. Mrs. Stern states: Oh, those are mine, so I figured we’d use them up first.6) What teaching do you need to do with Mrs. Stern? How come Mr. Stern needs more Lasix than Mrs. Stern? Which electrolyte should be monitored when a patient is taking diuretics?  The KCL label states: 20 meq PO od. Mrs. Stern states: We both take one of them. This medication has not been prescribed for Mrs. Stern.7) What do you tell Mrs. Stern about the signs and symptoms of hyper and hypokalemia? Who is at risk for hypokalemia? Hyperkalemia? What is a normal potassium level?   You inspect Mr. Stern’s arms and chest and do not see any nitrol ointment. Mr. Stern tells you that when it falls off he waits until his wife comes home to put on a new one.8) How does the nitrol ointment help Mr. Stern? With a physician’s order, what might be a practical alternative for the delivery of the nitroglycerin ointment?    Mrs. Stern tells you she must leave for work. She is grateful for your interventions and treatment. You make a follow-up appointment to see the Sterns in 2 days to assess the efficacy of teaching and reassess Mr. Stern for signs of improvement of CHF. You are concerned over Mr. Stern’s being home alone.9) Why do you think Mrs. Stern must work? How could Mr. Stern be monitored or cared for while Mrs. Stern is at work?   Health Science Science Nursing NURSING 223 Share EmailCopy link Comments (0)

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