Dysrhythmia Case StudyName: Margaret Brown Age: 87Provider: Dr. Griffin Allergies: ketorlacCode Status: Full Admit Wt.: 73.6 mg BMI: 27.8NURSING NOTE0845Pt arrived to ED by EMS. Husband stated he called the ambulance after his wife “passed out” this morning when they got up. He stated she has been “very tired and weak for a while” and c/o “trouble breathing” for the same period of time. The pt states she has been dizzy at home too. States she has been nauseous but denies vomiting. Denies any chest pain, palpitations, or any other symptoms.Pt now awake, but drowsy. Alert and oriented x 4. PERRLA. No JVD noted. Lungs sounds clear bilaterally. Equal chest rise and fall. Respirations unlabored at this time but tachypnea noted. Heart sounds noted brady, S1, S2 noted. No abnormal sounds noted. Abdomen soft, nontender. Bowel sounds active x 4 quadrants. C/o nausea. Pulses noted 1+ in all extremities bilaterally. Cap refill > 3 seconds. Pallor noted with skin noted cool and clammy.Home medications:Furosemide 40 mg PO dailyMetoprolol tartrate 100 mg PO BIDAspirin 81 mg PO dailyDigoxin 125 mcg PO dailyClopidogrel 75 mg dailySimvastatin 40 mg PO dailyPotassium 20 meq PO dailyProtonix 40 mg PO dailyLevothyroxine 75 mcg PO dailyCalcium/Vitamin D 600/400 PO dailyHx: appendectomy, cholecystectomy, left knee replacement, hysterectomy, TIA, carpel tunnel, pneumonia, HTN, MI, atrial fibrillation, CAD, GERD, constipation, UTI, hypothyroid0904Atropine 1 mg given IV0907Atropine 1 mg given IV.0910Transcutaneous pacing initiated per protocol.VITAL SIGNSVitals / Date-TimeTemperaturePulseResp.Blood PressureO2 Sat.0845 97.9? F362881/5290% RA0855 97.8? F382982/4994% 4L oxymask0900 97.8? F412880/5096% 6L oxymask0905 97.9? F502683/5296% 6L oxymask0910 97.9? F602584/4995% 6L oxymask0915 97.8? F612685/5094% 6L oxymask0920 97.7? F592487/5596% 6L oxymask0925 98? F602590/5095% 6L oxymask0930 97.6? F612389/4995% 6L oxymaskHEALTH CARE PROVIDER PRESCRIPTIONS/NOTES08502 large bore IV placementsContinuous cardiac monitoringO2 to keep sat > 93%Monitor vital signs every 5 minutesSTAT labs: CBC, CMP, BNP, Digoxin level, Mg level, ABG, PT/INR, PTT, TroponinSTAT EKGCXRAtropine per protocolTranscutaneous pacing per protocolTransfer patient to CCU and call cardiology for additional orders.LAB RESULTSLab ResultNormal Range0915Date/TimeDate/TimeDate/TimeWBC5-107.6RBC4.2-6.15.8Hemoglobin12-1612.6Hematocrit37%-47%37.8Platelets150-400222Sodium135-145143Potassium3.5-55.4BUN10-2018Creatinine0.5-1.11.3Magnesium1.7-2.21.5BNP<10098Digoxin Level0.8-2 ng/mL2.5PT11-12.5 seconds11.5INR0.8-1.11.0PTT60-7065Troponin I<0.03 ng/mL0.01pH7.35-7.457.41paCo235-45 mmHg38paO280-100 mmHg85HCO322-26 mEq/L23Telemetry Monitoring Strip:When looking at Ms. Brown’s labs, are there any labs you are concerned about? If so, what are they and why?
Ms. Brown’s current problem has not resolved in 4 days. The cardiologist decides she needs a permanent pacemaker implanted.What will you monitor her for in the immediate post-operative period? List at least 4 things.What education do you, as the nurse, need to provide to Ms. Brown prior to discharge? List at least 5 points you will need to teach.
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