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Lani S.
Lani S., Tutor
Category: Homework
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Experience:  Registered Nurse, Internet Researcher, Private Tutor
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Clinical Scenario #2: This is a 72 year old female Lasix

Customer Question

Clinical Scenario #2:

This is a 72 year old female Lasix who presented to the hospital with shortness of breath for 2 days. She reported running out of her 4 days prior and missed 2 doses that day. Her Lasix dose was increased 6 months prior from 40 mg daily to 40 mg BID without any complaints.
Intake history:
CC: To the ER with shortness of breath
HPI: Increased shortness of breath for 2 days, increased lower extremity edema, harder to breath when lying flat and when she walks.
PMH: CAD, MI, CHF with an EF of 40%, HTN, DM, neuropathy, GERD, COPD, cataracts, glaucoma, chronic back pain, L2-L3 laminectomy, hyperlipidemia and breast cancer.
VS: 168/89, 89, 18, 98.2 and the oxygen saturation was 98% on 2 liters.
Physical Examination:
• General: Moderate distress, sitting upright in her bed with oxygen via nasal canula.
• Skin: Warm, dry
• HEENT: normal
• Neck: Supple, no carotid bruits
• Chest examination: slight bibasilar rales and slight expiratory wheezing
• Cardiac: regular heart rate and rhythm with a systolic murmur heard at the left sternal border
• Abdomen: soft and nontender with slight distention
• Extremities: 1 plus pitting edema of the bilateral lower extremities with chronic skin changes
• Neurological: Alert and oriented x3, 4/5 strength of the bilateral lower extremities, which is normal for her
Laboratory studies: WBC count 8.2, H/H 12.1/31, platelet count 297, BUN 15, creatinine 0.9, sodium 140, potassium 3.3, glucose 190, albumin 3.6, INR 0.9, BNP 119, troponin I 0.01 (less than 0.04).
CXR: Early vascular congestion with chronic COPD changes
EKG: sinus rhythm with an old lateral wall infarction, RBBB and left axis deviation, no changes when compared to a prior EKG
Impression: CHF
The plan of care: telemetry, serial cardiac enzymes times 3, repeat CXR, IV Lasix 40 mg BID, oxygen 2 liters PRN, albuterol/Atrovent nebulizers tid and a Cardiology consultation.

Questions for Clinical Scenario #2:

1. What is the significant clinical information in the above scenario that would help you make a decision for Inpatient or Observation services for this patient? Please include objective/subjective clinical information. Why?












2. Do you have all the information you need? If not, please list what additional information you would like provided to make your decision.
Submitted: 4 years ago.
Category: Homework
Expert:  Josie-Mod replied 4 years ago.
Hi, I’m a Moderator for this topic and I wonder whether you’re still waiting for an answer. If you are, please let me know and I will do my best to find a Professional to assist you right away. If not, feel free to let me know and I will cancel this question for you. Thank you!
Customer: replied 4 years ago.
Yes, I am still waiting for an answe. Thanks
Expert:  Josie-Mod replied 4 years ago.
Hi,

Thank you for your reply. Sometimes, finding the right Professional can take a little longer than expected and we thank you greatly for your understanding. We’ll be in touch again shortly.
Expert:  Lani S. replied 4 years ago.

Hi,

Do you still need help on those questions? If so, I would need to know the following:

-the length/word number requirements for the answer to each question.

-for the question #2, does that refer on making decision on what interventions to apply when making nursing care plan? Please explain further what you need in this question.

Thanks.

Customer: replied 4 years ago.
There is no word length requirement. On question two it wants to know if the information listed is enough to make a. clinical nursing diagnosis
Expert:  Lani S. replied 4 years ago.

You use NANDA-I as reference for Nursing Diagnosis, am I right?

When do you need these?

Thanks.

Customer: replied 4 years ago.
Yes, need it by the end of tonight. Thanks
Customer: replied 4 years ago.

Hi Lani,

Have you answered the two questions?

Thanks!

Customer: replied 4 years ago.
Hello, I still havent received a response, are you going to work on that for me?
Expert:  Lani S. replied 4 years ago.

Hi,

I have the answers ready but couldn't come online earlier, sorry. I can post it if you still need it. Thanks.

Customer: replied 4 years ago.
Yes, I still need it. Thanks
Expert:  Lani S. replied 4 years ago.
THIS ANSWER IS LOCKED!

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Lani S., Tutor
Category: Homework
Satisfied Customers: 4660
Experience: Registered Nurse, Internet Researcher, Private Tutor
Lani S. and 2 other Homework Specialists are ready to help you
Customer: replied 3 years ago.

Hi Lani,

 

I need your help desperately. I have a question posted and can pay $80 or more with a good tip. Will you look at question and see if you are able. It's a 5 pg nurse care plan.

 

Thanks,

Expert:  Lani S. replied 3 years ago.
I think that post has been answered. :)
Customer: replied 3 years ago.
Yes, it has. The question was posted over 2 days ago. Thanks!