75 yo M admitted yesterday with 3 days of progressive SOB,cough, and fever. Physicial assessment shows right sided cracklesand hypoxia. CXR confirms RML infiltrate. Patient placed on O2 andadmitted to the floor. This evening develops sudden increased SOBand palpatations, while returning from a smoke. No chest pain, nofevers, no chills. Now admitted to ICU as he develops RapidA-fib.
Past Medical History:
- CAD
- NSTEMI 2003 with RCA stent,
- NSTEMI 2010 with LAD stent x 2
- CHF – secondary to ischemic cardiomyopathy, EF 45%
- Dyslipidemia
- HTN
- COPD
Social History:
Married with 2 children, lives at homewith wife, worked as a mechanic, no alcohol or drugs. > 50 packyear smoking history
Medications:
- Metoprolol 25mg po BID
- Ramipril 10 mg po Daily
- ASA 81 mg po Daily
- Plavix 75mg po Daily
- Lipitor 40 mg po Daily
- Spiriva 18mcg 1 puff inh Daily
Initial Parameters:
Patient: Patient uncomfortable, SOB, but able to answerquestions.
Vitals: HR 146 BP 95/50 (anddropping) RR 22 Temp 36.7C O2 sat 93% on 3L
Neuro: Eyes open, pupils equal and reactive
Lungs: Crackles at bases R > L
Cardiac: Normal S1, S2, no murmur, mild peripheral edema,elevated JVP
Abdo: Soft, not tender, no masses
Labs: AM Bloodwork (K Normal at 3.6, WBC 14.2, Glucose 8.9)
CXR: RML infiltrate
ECG: Rapid Atrial Fib (rate 143-168)-average HR is 146bpm
What are the nursing considerations for this patient ( considerboth current and previous events).
