Critical care nursing Essay Example | Topics and Well Written Essays - 1500 words

Critical care nursing - Essay Example The drugs prescribed demonstrate that the endeavor was to keep her blood pressure within normal limits, to keep her cholesterol levels in check and prevent any further cardiovascular complications, primarily as a measure to reduce the risk of a heart attack (NIH). The prescribed drugs are standard regimen to keep the blood thin, control blood pressure and reduce hyperlipidemia. However, 5 days post-discharge, the woman was presented again at the emergency department with the primary complaint being that of sudden onset of breathing difficulty. According to her husband’s statement, the woman had probably forgotten to take some of the prescribed medication, had undergone stress due to current heat wave, and had exerted herself while making preparations for the ensuing Christmas celebrations. Vital signs as registered on arrival at the emergency facility included a respiratory rate of 28, heart rate of 130 suggestive of rhythm sinus tachycardia, a B.P. of 140/100, oxygen saturati on of 94% on 6 litre oxygen via facemask and a capillary refill value greater than 3 seconds. On palpation her skin felt cold as well as clammy. Upon lung auscultation, bilateral fine crackles were discernible. Immediate treatment recommended and provided at this stage was in the form of GTN (Nitroglycerine) infusion and an IV diuretic, frusemide at a dose of 40 mg after which she was shifted to the ICU. In the ICU, sinus tachycardia was observed along with a HR (Heart Rate) of 133. ECG (electrocardiograph) revealed resolving acute anterior septal myocardial infarction with present Q wave. She had marked hypotension with a value of 85/70 and JVP was estimated at 6 cms above the sternal angle. Echocardiography revealed an ejection fraction of 50% with poor diastolic filling. Respiration was shallow and tachypnoeic with a RR of 35. Despite a supplement of 10L/Nonbreathing mask oxygen therapy, she continued to maintain poor oxygen saturation at 80-90%. Her pain score was determined as 5/10 and the urine output was 200mls. GTN infusion was discontinued and she was put on dobutamine at a dose rate of 500 mg/100 mls in 5% dextrose titrated to a MAP of 70 mm Hg. Mask CPAP was initiated. The woman’s age, BMI and the clinical symptoms presented clearly show that she is at a clear risk of a sudden onset heart attack which has occurred according to her presented symptoms on admission at the emergency facility. Such acute heart failure syndromes (AHFS) are a recognized reason for the high rise of cases needing hospitalization over the last few decades due to rising incidence of lifestyle diseases (Coons et al, 2009). The risk of mortality is high in such cases and therapy has to be instituted immediately. The above patient’s history, signs and investigative laboratory scores clearly show that she is suffering from acute onset heart failure. Her low BP (85/70), evidence of sinus tachycardia (HR 133), poor diastolic filling suggestive of reduced left ventricul ar ejection fraction (LVEF), low RR (35) and poor oxygen saturation despite artificial support are clear markers for her diagnosis (Coons et al, 2009). Although the above signs are sufficient for establishing diagnosis of AHFS, it has been suggested that newer diagnostic markers such as cardiac troponin and B-type natriuretic peptide levels can assist in establishing a positive diagnosis and should be employed (Pulkki et al,