NR 324 Case Study Review the patient profile and type the answers below in detail and in your own words. Any copy and pasting will result in a zero (0) and is a direct violation of the academic integrity policy. Patient Profile M.G. is a 77-year-old woman who saw her health care provider for dyspnea. She is now being admitted to the hospital for acute SOB and dyspnea. She is currently taking the following medications: Furosemide (Lasix) 40 mg PO daily Potassium chloride (K-tab) 20 mEq PO daily Enalapril (Vasotec) 10 mg by mouth BID Subjective Data Was taking furosemide (Lasix) at home but ran out two days ago and has not been able to refill her prescription Complains of difficulty breathing; had to “sleep in the chair” last night Has some swelling in her feet that is worse than usual Objective Data Physical Examination Temperature 98.4° F, pulse 92, respirations 24, blood pressure 144/86, oxygen saturation 89% on room air Height 5’5”, weight 170 lb Alert and oriented to person, place, and time Fine crackles bilateral lower lobes Shortness of breath with minimal exertion S1 and S2 without murmur or extra heart sounds Capillary refill sluggish in lower extremities, normal in upper extremities 2+ pitting edema bilateral lower extremities Collaborative Care Admission orders include: Oxygen 2 L per nasal cannula Furosemide (Lasix) 40 mg intravenous BID Enalapril (Vasotec) 10 mg by mouth BID ECG now Vital signs with pulse oximetry every four hours 2-gram sodium diet Accurate 24-hour intake and output (I/O) Daily weight Bed rest until SOB resolves, then up to chair with assistance TID NR 324 Case Study 1. Describe a plan for implementing these physician orders in order of priority. (1 point) 2. Based on M.G.’s clinical manifestations, what type of heart failure do you suspect and why? Hint: right sided, left sided or both (1 point) 3. What assessment data will you use to determine the effectiveness of the physician’s orders? In other words, how will you determine that the ordered medication/treatments are working? (1 point) 4. What is the rationale for the oxygen, IV furosemide (Lasix), and enalapril (Vasotec)? How are they working within the body? (2 points) 5. Based on the above MD orders for furosemide: (10 points) a. If you have furosemide 100mg/mL on hand, how many mL’s would you administer for this patient? b. What classification is furosemide? c. Give two examples of other medications in the same class. d. What is the action of furosemide? e. How can furosemide can be given? f. What is the normal dosage of furosemide? g. What is the expected response of furosemide? h. What potential side effects would you monitor for? i. What nursing considerations when administering IV furosemide? j. What labs would you monitor and expect? 6. Based on the above MD orders for enalapril: (10 points) a. If you have enalapril 20mg on hand, how many tablets would you administer? b. What classification is enalapril? c. Give two examples of other medications in the same class. d. What is the action of enalapril? e. How can enalapril can be given? f. What is the normal dosage of enalapril? g. What is the expected response of enalapril? h. What potential side effects would you monitor for? i. What nursing considerations when administering PO/IV enalapril? j. What labs would you monitor and expect? NR 324 Case Study 7. What are two priority nursing diagnoses for this patient? Include related to and as evidenced by for each one. (1 point) 8. What other orders might you anticipate for this patient? Give two examples. (1 point) 9. What other complications is the patient at risk for due to immobility and what can be anticipated to prevent each of them? (1 point) 10. The next day the nurse assesses the patient and finds: (2 points) o o o o Temperature 98.4° F, pulse 92, respirations 24, blood pressure 90/62, oxygen saturation 96% on 2L nasal cannula Clear lung sounds, peripheral edema nonpitting +1 Labs: BUN: 25 mg/dL, CO2: 22 mmol/L, Creatinine: 1.2 mg/dL, Glucose 99 mL/dL, Sodium 135 mmol/L, Potassium 3.1 mmol/L, Chloride 100 Morning Meds: Furosemide (Lasix) 40 mg intravenous BID/ Enalapril (Vasotec) 10 mg by mouth BID Based on the above assessment and morning laboratory results, what would be the priority nursing interventions and what other orders might you anticipate for this patient?