Congestive Heart Disease And Dysrhythmias Essay Discussion
NURSING 527 – NURSING CARE PLAN (NPR) SITUATIONS Nursing 527: simulated – Prototype Client Situation (1997). Use for NPR assignments \& final exam. Get to know this client as a living, breathing person, who is trying to adapt to a significant change. Mr. Code Red, a 68-year-old male with a stroke (Please review CVA (stroke) in your med/surg teatbook) Mr. CR, a marred, semi-retired accountant, was admitted to the hospital 6 days ago, after his wife; Clara was unable to arouse him in the morning. He has a history of congestive beart disease and dysrhythmias. Initially she though he had had a “heart attack” but she was able to feel a pulse and hear his noisy thonchial breathing He was admitted to the ICU for evaluation and initial management. The MRI revealed a lef-sided cerebral arterial thrombosis with infarction, ischemia and decreased blood flow to the frontal and parietal areas. On questioning, she recalled that . Red had difficulty speaking spontaneously and complaned of numbness and slight weakness in his right arm before retiring for the night. They both thought he as just “tired”, and made plans to check with his physician the next day if he was not feeling better. During his ICU stay he as given medication to decrease cerebral edema, control his clotting process, and maintain his blood pressure and heart rate and rhythm within his therapeutic range. Fluid balance was maintained with IV’s. A Foley catheter was inserted to measure output and control incontinence. Congestive Heart Disease And Dysrhythmias Essay Discussion
About 24 hours atter admission he began to respond to stimuli, look at his wife when she talked to him, move his left extremities on request, and slight movement of his right. He was unable to speak coherently. although he attempted to form words. Because he choked when attempting to swallow, a naso-gastric tube was placed in order to administer tube feedings. Now stable, be has been transferred to the medical-neurology unit to begin rehabilitation. Assessment behaviors this morning include the following: O2 T. F., P. 88 irregular, slightly weak; R. 24 shallow, decreased breath sounds in the bases with coarse thonchi audible in perpheral airways; B P. 130-150-80-100 supine with at . Awakens to being called by name and makes eye contact. Attempted no speech. Reached out with left hand to wife when she visited. Watched TV when college football game on Dozing when left alone. Breathing increased to rate of 30 , irregular, snoring when sleeping and or bead forward on chest 02 by nasal cannula at in place. Diaphoretic, warm, pale skin PMI left of midclavicular line, with Xusble lift Apical pulse irregular, hard to hear with noisy breathing Peripheral pulses weak fill time. Confimed sensation to touch and movement intact to L. extremities. Could not confirm on nght. . And hematocrit Platelets WNL. Partial thromboplastin time (PTT) prolonged to 60 sec. with ongoing heparin therapy. F/E: Has IV of DS with at hour on IVAC pump into L. forearm. Area intact without swelling, tendemess, or warmth Urinary output clear, pale yellow via condom cathefer Has 1-2t edems on R. hand and R lower ankle and foot. Edema decreases when extremties elevated Serum electrolytes show Na L, K . client recerves LasD 20 mgm BID IVP with increased urinary Congestive Heart Disease And Dysrhythmias Essay Discussion
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Based on the provided information, Mr. Code Red is a 68-year-old male with a stroke who was admitted to the hospital 6 days ago. He has a history of congestive heart disease and dysrhythmias. Mr. Red’s stroke affected the left side of his brain, resulting in difficulty speaking coherently, numbness, and slight weakness in his right arm. He has been stabilized with medication to control cerebral edema, clotting process, and maintain blood pressure and heart rate within therapeutic range. Mr. Red has been transferred to the medical-neurology unit to begin rehabilitation.
This morning, Mr. Red’s vital signs indicate a slightly elevated temperature, irregular and slightly weak pulse, shallow breathing with decreased breath sounds in the bases, and coarse rhonchi audible in peripheral airways. He awakens to being called by name and makes eye contact but does not speak. He is able to move his left extremities and watches TV when a college football game is on, but dozes off when left alone. His skin is diaphoretic and pale, and he has edema on his right hand and lower ankle and foot. Mr. Red is receiving IV fluids and Lasix to maintain fluid balance and urinary output. He is also receiving ongoing heparin therapy to control clotting. He has a Foley catheter inserted to measure output and control incontinence, and a nasogastric tube to administer habitation feedings as he chokes when attempting to swallow.
Overall, Mr. Red’s current nursing care plan should focus on managing his vital signs, monitoring and managing his fluid balance, and facilitating his rehabilitation process. Communication and positioning strategies may be needed to support his speech and mobility, respectively. Close monitoring of his response to interventions, medication administration, and safety precautions (e.g., preventing aspiration and falls) should be prioritized.
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