McClainHannahCaseStudy2.docx - NURS 4503 Written Case Study...

NURS 4503 Written Case Study (#2)
Directions: This assessment should be completed individually, not with another
student.
For each answer, you should provide a rationale and reference. Be thorough in
your answers.
Critically Ill Patient
A. Patient Profile
R.B. is a 55-year-old female who presented to the emergency department (ED)
via ambulance for acute shortness of breath. Her daughter called an ambulance
after finding her mother with an increased respiratory rate and shortness of
breath. Upon arrival to the ED, R.B.’s respirations were 40 and shallow with
wheezing in the lower lobes and rhonchi in the upper lobes bilaterally. She had
positive jugular vein distention and a heart rate of 128. After treatment with
albuterol nebulizer via mask, her vital signs were temperature 96.8˚ F, pulse 98,
respirations 18, blood pressure 148/84, and O
2
saturation 94% with 15 LPM via
mask. Arterial blood gasses showed her pH 7.19, pC02 90, PO
2
92%, HC0
3
38.
R.B. was intubated for hypercapnia. After an echocardiogram showed an ejection
fraction less than 50%, she had an emergency left heart catheterization done
with two stent placements into the left anterior descending artery. A pulmonary
artery catheter was placed and the initial hemodynamic readings show elevated
left ventricular preload. R.B. is now being transferred to the ICU.