Nursing situation CHF

CHF nursing situationPatient 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 3Admitted for CHF exacerbation, pneumonia, acute on chronic renal diseaseYou 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 walkerIn the ED, he received IV furosemide 40mg, 650mg Tylenol, 500mg IV levofloxacin and an albuterol/ipratropium nebulizer treatmentSelected labs, diagnostics, and ordersWBC18.2Hgb10.4K (potassium)3.1creatinine4.1blood glucose308BNP8023Urine – bloodlargeUrine – leukocytes+3Urine – culturependingCOVID 19 PCR – negativechest x-raybilateral infiltrates, pleural effusionssputum sample to be collectednormal sinus rhythm on tele monitorvital signs170/64, P55, R23, O2 90% room air, temp 100.4, ht 178cm, wt 90kgDiet: cardiac, 1800 ADA, 1 liter free water restrictionActivity: as toleratedStrict I&Ohome medications – have all been profiled to  MARHospital medsmetoprolol25mgBIDalbuterol/ipratropiumQ6hrsamlodipine5mgQAMfurosemide IV40mgonce 6pmlisinopril20mgQAMlevafloxacin IV500mgQ24hrsatorvastatin40mgQPMtylenol650mgQ6hrs  PRNtamsulosin0.4mgQPMIV potassium  10 meqx3clopidogrel75mgQAMaspirin81mgQAMescitalopram10mgQAMmetformin1000mgBIDtramadol50mgQ8hrs PRNgabapentin200mgBIDtemazepam7.5mgQHS PRNConsults pending – cardiology, ID, nephrologyPersonal historyformer smoker, quit 35 years agodoes not drink alcoholdid not get flu shot this yearDiscussionWhat 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 callWhat does each medication do?  Would you hold any?Additional assessment to document in EHR:GI – bowel sounds in all quadrants, soft non-tenderGU – noted this in urinalCardiac S1S2, pulses ok in all ext, normal cap refillHEENT – seems a bit hard of hearing, head without wounds, eyes, nose, oral mucosa ok. Has dentures (upper and lower)Resp – seems to cough a lot after drinking water/taking pillsPain – no issuesIV – left forearm 20g, flushes well, no leaksPossessions – has glasses, iPhone, bottle of home tramadolRetired engineer, married, lives at ALF with spouse

 

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