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Medical-Surgical Nursing

Chapter 12

Medical-Surgical NursingChapter 12

Chapter 12

Unfolding Case Study

1.
CUE Acute MI Possible sepsis Bacterial pneumonia
Respiratory failure X
Decreased cardiac contractility and dysfunction X
Lactic acid increased X
Rationale: Cardiac myocytes require adequate coronary perfusion for contractility. Decreased cardiac output due to left ventricular dysfunction as a result of the anteriolateral wall MI. Cardiogenic shock of the anterior wall MI is associated with higher hospital mortality when compared to solely an inferior MI. Systolic heart dysfunction has a higher rate of mortality. Hypovolemic shock and cardiogenic shock can lead to sepsis and septic shock. The patient is acidotic (increased lactic acid and respiratory acidosis), hypotensive, and hypovolemic. If the patient’s cardiac decompensation is reversed, the progression of sepsis/septic shock may be adverted. The respiratory failure treatment has already been initiated with antibiotic therapy and mechanical ventilation.
2.

Intervention: Administer vasopressors IV; Rationale: Hypotension, decreased cardiac contractility; Intervention: Hemodynamic monitoring; Rationale: Monitor the effectiveness of therapeutics for pulmonary and heart function

Rationale: Cardiac decompensation can begin to negatively affect the body’s organs, and the administration of vasoconstrictors is necessary to increase tissue perfusion to the patient’s organs. In addition to fluid resuscitation, IV vasopressor therapy is a fundamental treatment of possible septic shock-induced hypotension, as it aims at correcting the decreased vascular tone and improving organ perfusion pressure. Antiplatelets or anticoagulants are administered for patients who have had an MI to prevent the formation of blood clots. Positive end-expiratory pressure is not necessarily a treatment for bacterial pneumonia. PEEP maintains the expansion of the alveoli at the end of the patient’s respiration. Diuretics are not administered if the patient is hypotensive or had a significant drop in BP from baseline.

Read the Electronic Health Record

1.
The patient has a low potassium and a low magnesium.
2.
Normal potassium levels should be between 3.5 and 5.0 and magnesium should be greater than 2.0.
3.
The nurse should review the telemetry to see if there is any ectopy on the monitor. A set of vitals should be obtained. The nurse should get an order for electrolyte replacement.
4.
Over the span of 15 hours, Mr. Smith’s BNP is trending up, suggesting worsening HF.
5.
The elevation in the liver function tests indicates liver damage, likely from right-sided heart failure, and the patient will likely have increased abdominal ascites and hepatosplenomegaly.
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