Dysrhythmia Case Study Name: Margaret Brown Age:

Dysrhythmia Case Study Name: Margaret Brown Age: 87 Provider: Dr. Griffin Allergies: ketorlac Code Status: Full Admit Wt.: 73.6 mg BMI: 27.8 NURSING NOTE 0845 Pt arrived to ED by EMS. Husband stated he called the ambulance after his wife “passed out” this morning when they got up. He stated she has been “very tired and weak for a while” and c/o “trouble breathing” for the same period of time. The pt states she has been dizzy at home too. States she has been nauseous but denies vomiting. Denies any chest pain, palpitations, or any other symptoms. Pt now awake, but drowsy. Alert and oriented x 4. PERRLA. No JVD noted. Lungs sounds clear bilaterally. Equal chest rise and fall. Respirations unlabored at this time but tachypnea noted. Heart sounds noted brady, S1, S2 noted. No abnormal sounds noted. Abdomen soft, nontender. Bowel sounds active x 4 quadrants. C/o nausea. Pulses noted 1+ in all extremities bilaterally. Cap refill > 3 seconds. Pallor noted with skin noted cool and clammy. Home medications: Furosemide 40 mg PO daily Metoprolol tartrate 100 mg PO BID Aspirin 81 mg PO daily Digoxin 125 mcg PO daily Clopidogrel 75 mg daily Simvastatin 40 mg PO daily Potassium 20 meq PO daily Protonix 40 mg PO daily Levothyroxine 75 mcg PO daily Calcium/Vitamin D 600/400 PO daily Hx: appendectomy, cholecystectomy, left knee replacement, hysterectomy, TIA, carpel tunnel, pneumonia, HTN, MI, atrial fibrillation, CAD, GERD, constipation, UTI, hypothyroid 0904 Atropine 1 mg given IV 0907 Atropine 1 mg given IV. 0910 Transcutaneous pacing initiated per protocol. VITAL SIGNS Vitals / Date-Time Temperature Pulse Resp. Blood Pressure O2 Sat. 0845 97.9° F 36 28 81/52 90% RA 0855 97.8° F 38 29 82/49 94% 4L oxymask 0900 97.8° F 41 28 80/50 96% 6L oxymask 0905 97.9° F 50 26 83/52 96% 6L oxymask 0910 97.9° F 60 25 84/49 95% 6L oxymask 0915 97.8° F 61 26 85/50 94% 6L oxymask 0920 97.7° F 59 24 87/55 96% 6L oxymask 0925 98° F 60 25 90/50 95% 6L oxymask 0930 97.6° F 61 23 89/49 95% 6L oxymask HEALTH CARE PROVIDER PRESCRIPTIONS/NOTES 0850 2 large bore IV placements Continuous cardiac monitoring O2 to keep sat > 93% Monitor vital signs every 5 minutes STAT labs: CBC, CMP, BNP, Digoxin level, Mg level, ABG, PT/INR, PTT, Troponin STAT EKG CXR Atropine per protocol Transcutaneous pacing per protocol Transfer patient to CCU and call cardiology for additional orders. LAB RESULTS Lab Result Normal Range 0915 Date/Time Date/Time Date/Time WBC 5-10 7.6 RBC 4.2-6.1 5.8 Hemoglobin 12-16 12.6 Hematocrit 37%-47% 37.8 Platelets 150-400 222 Sodium 135-145 143 Potassium 3.5-5 5.4 BUN 10-20 18 Creatinine 0.5-1.1 1.3 Magnesium 1.7-2.2 1.5 BNP <100 98 Digoxin Level 0.8-2 ng/mL 2.5 PT 11-12.5 seconds 11.5 INR 0.8-1.1 1.0 PTT 60-70 65 Troponin I <0.03 ng/mL 0.01 pH 7.35-7.45 7.41 paCo2 35-45 mmHg 38 paO2 80-100 mmHg 85 HCO3 22-26 mEq/L 23 Telemetry Monitoring Strip: 1. What are 4 findings from Ms. Brown's EHR that require immediate follow-up? Why? 2. What could be causing Mrs. Brown's current problem? Explain your answer.

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