CLINICAL CASE DECISION INSTRUCTIONS

Clinical case decision instructruction | Nursing homework help

The intent of Mrs. Muller’s management would be to stabilize her condition, treat her acute heart failure, and improve her cardiogenic shock. The management plan should include administering oxygen to improve her oxygenation, administering nitroglycerin to dilate her coronary arteries, administering diuretics to reduce fluid buildup in her lungs, administering inotropes or vasopressors to improve her heart function and blood pressure, and conducting an echocardiogram to assess the extent of her cardiac damage. Additionally, Mrs. Muller should be monitored closely for signs of worsening heart failure and shock, such as decreased urine output, altered mental status, and worsening hypotension.

Nursing Diagnosis: Impaired gas exchange related to pulmonary congestion as evidenced by shortness of breath and cyanosis.

Plan of Care:

• Administer oxygen via nasal cannula at 2L/min to improve oxygenation
• Administer diuretics (such as furosemide) to reduce fluid buildup in lungs and improve breathing
• Monitor vital signs, including oxygen saturation, blood pressure, and heart rate
• Monitor intake and output to assess fluid balance
• Monitor for signs of worsening heart failure and shock
• Conduct daily weights to assess fluid changes

Reference: Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2017). Brunner & Suddarth’s textbook of medical-surgical nursing. Wolters Kluwer.

C4. In response to John’s blood loss, his body will experience several physiological responses aimed at compensating for the loss of blood volume. Initially, his sympathetic nervous system will activate to stimulate the release of epinephrine and norepinephrine, which will increase heart rate and contractility, constrict blood vessels, and increase blood pressure. This response will help to maintain blood flow to vital organs, such as the brain and heart, and prevent further blood loss. John’s kidneys will also release renin, which will activate the renin-angiotensin-aldosterone system to increase blood volume by retaining sodium and water in the body. As a result, his urine output will decrease, and he may develop thirst.

Nursing Diagnosis: Decreased tissue perfusion related to blood loss as evidenced by laceration of radial artery.

Plan of Care:

• Administer fluids, such as normal saline or lactated Ringer’s solution, to restore blood volume
• Monitor vital signs, including blood pressure, heart rate, and oxygen saturation
• Monitor intake and output to assess fluid balance
• Monitor for signs of hypovolemic shock, such as altered mental status, decreased urine output, and cold clammy skin
• Elevate the affected arm to reduce swelling and promote venous return
• Apply pressure to the laceration site to control bleeding
• Prepare for possible blood transfusion or surgery, depending on the extent of blood loss

References: Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology. Elsevier. Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M., & Kwong, J. (2017). Medical-surgical nursing: Assessment and management of clinical problems. Mosby.