umc2_heart failure case study.pdf - Heart Failure Case...

Heart Failure Case Study
Part 1
Issue
Pediatric scenario: A 16-year-old girl is admitted to the ER with supraventricular tachycardia (no
reported use of illicit drugs)
Introduction
You are working in the emergency department of a children’s hospital. A 16-year-old female arrives with
friends. She is obviously short of breath and diaphoretic. You have her lie down on a cart. You connect a
cardiorespiratoryoximetry monitor. Her heart rate on the monitor is 300 beats per minute. Her
respiratory rate is 60 breaths per minute. Her oxygen saturation is 80%. She has a mild elevated
temperature. All of these signs point to a heart that is working too hard. You immediately summon the
physician (or nurse practitioner or physician’s assistant, whoever has the authority to prescribe orders).
You start her on oxygen by nasal cannula, high flow. By auscultation, her heart rate is too fast to obtain.
Her lungs sound clear. You draw labs for a Complete Blood Count, blood gas (ascertain how the lungs
are exchanging oxygen), lactic acid (is the heart muscle working so hard that it is creating excessive lactic
acid?), cardiac enzymes, complete blood panel (including electrolytes, because you do not know yet if
this heart condition is related to the electrical conductivity of the heart), and generally other tests
(glucose, BUN, creatinine, because you want to know how other body and organ systems are affected).
You also draw blood cultures (on the outside chance it is a bacteria causing her elevated heart rate).
You ask the patient for her parents’ phone numbers, she obliges, and you c all her parents. You explain
what is happening and while you have them on the phone, you ask if the patient is on any medications
or allergic to anything (no regular medications and not allergic to anything). You advise them to come
right away.
Patient History and Parent Questions
You ask the patient if she has taken any medication, legal or illegal. You explain that you (the nurse) do
not care from a legal standpoint what she has taken, but it is imperative that she tell you in order for
you to treat her. You continue to ask the patient questions about medication, lifestyle, activities,
frequency of episodes, etc. The patient’s parents arrive. Mom states the patient takes multivitamins and
“some herbs to help with her energy, because she has been tired over the past month.”
All the while you are asking questions (obtaining a history), she is becoming more lethargic. You are
unable to get a blood pressure on her. An EKG has been ordered and completed and the cardiologist is
consulted. Your patient is diagnosed with supraventricular tachycardia. You are not able to get a blood
pressure. You know this means that her heart is functioning poorly, unable to perfuse well enough
through her body, resulting in the inability to obtain a blood pressure. You and the healthcare team
make immediate arrangements and transport her to pediatric intensive care.