Case Study #2: 2.What is the primary problem, and what is its…

Question Case Study #2: 2.What is the primary problem, and what is its… Case Study #2: 2.What is the primary problem, and what is its underlying cause or pathophysiology? Explain in detail.The 70-year-old male patient was just transferred from the ICU and is postoperative day 2 after a three-vessel coronary bypass graft surgery. Hx is hypertension, hyperlipidemia, and type 2 diabetes mellitus requiring insulin for the past 6 months to control glucose levels.  Post transfer assessment and vital signs are: Temperature- 36.8 C. orally Apical Pulse- 61 and regular Respiratory Rate- 20 and regular Blood Pressure- 135/80 Left arm SP02- 96% on room air 1+ Pitting edema noted in lower legs. Chest- crackles noted in both bases Transfer report: The ICU nurse reported to you that there were complications during surgery and received 3 units of blood to treat hypotension since surgery. Since surgery, T.A. has experienced intermittent atrial fibrillation episodes, which is now under control with amiodarone and metoprolol. The ICU nurse reports that T.A’s urine output has been decreasing.The primary problem would be that T.A’s urine output has been decreasing, and the complications during surgery (receiving 3 units of blood to treat hypotension) and post-surgery (experiencing intermittent atrial fibrillation episodes) even though they have been under control since taking amiodarone, and metoprolol it is still worry sum where is he an older man and his age comes in to play. Another primary problem is his post transfer assessment as it was noted crackles in both bases. The underlying cause of having to have the three-vessel coronary bypass graft surgery could be from his past hx of hyperlipidemia (blood has to many lipids or fats such as cholesterol and triglycerides) which could have caused atherosclerosis, or coronary artery disease.  3. What clinical data from the chart would be RELEVANT and needs to be trended because of its clinical significance? Why is it relevant?  The clinical data from the chart that is relevant and needs to be trended because of its clinical significance is basically everything in the pt.’s chart from vitals, the chest – crackles noted in both bases, the decreasing in urine output, +1 pitting edema, and the treating of hypotension since surgery. It is relevant because the crackles heard could mean excessive fluid (secretions) in the airways, it can be caused by either pneumonia, or congestive heart failure. The urine output is relevant because it could mean there is urinary retention, a blockage, dehydration, or renal dysfunction. Anything that is significant to detect a change in status needs to be trended.  4. List all relevant nursing priorities. What nursing priority captures the “essence” of your patient’s status and will guide your plan of care? Explain why?  The relevant nursing priorities are    5. What nursing interventions will you initiate based on this priority and what are the desired outcomes? Explain in detail.    6. What body system(s), key assessments and psychosocial needs will you focus on based on your patient’s primary problem or nursing care priority? Explain in detail.   7. What is the worst possible/most likely complication(s) to anticipate based on the primary problem? Explain in detail.    8. What nursing assessments will identify this complication EARLY if it develops? Explain in detail.    9. What nursing interventions will you initiate if this complication develops? Explain the rationale for your interventions.   Case Study Progress… four hours after admission to the floor, you assess T.A. and gather the following data findings: • His total urine output of 75 mls. of dark amber urine. You check the urinary catheter tubing for obstructions and find none. • You assess T.A. abdomen and rule out urinary retention• Vital signs:    Temp- 36.9 orally Pulse- 74 regular Respiratory Rate- 22 regular Blood Pressure- 142/84 left arm. SP02- 96% on room air 2+ edema to both lower legs Audible crackles noted in both lung bases                            • Total Intake and Output for the last 24 hours: Intake- 1650 Output- 300 mls. • Daily weight increased from 62 kgs to 63 kgs in the last 24 hours. • Today lab results reported:  Chemistry:        Potassium 5.8 mmol/L Sodium 135 mmol/L Glucose 12.4 mmol/L BUN 30.7 mmol/L. Creatinine 389 mmol/L     Case Study Progress… The Cardiac Surgeon is on the floor and determines that T.A. has acute kidney injury and prescribes the following orders: • Furosemide 80 mg. IV daily • Sodium polystyrene sulfonate (Kayexalate) 1gram PO twice daily • Urgent insertion of Dialysis catheter in Interventional Radiology • Strict Intake and Output • Fluid restriction and Renal Diet • CBC, electrolytes, BUN and creatinine daily x 3  *Use the new information to respond to the following (While providing care, review and note after initial patient assessment)  10. What clinical assessment data has been presented that is RELEVANT and needs to be TRENDED because it is clinically significant to detect a change in status? Explain in detail.  The clinical assessment data that is relevant and needs to be trended because it is clinically significant to detect a change in status is  11. Does your nursing priority or plan of care need to be modified in any way after obtaining this new assessment data?  Health Science Science Nursing NURSING PATHO Share QuestionEmailCopy link Comments (0)