ED For Mrs. Kelly: A Case Study

Improved Essays
The primary survey carried out in ED for Mrs. Kelly included assessment of the airway, breathing, circulation, disability, exposure, fluids, and glucose levels (utilization of A-G assessment format). The assessment of the airway showed no signs of obstruction or noisy breathing and the patient was breathing spontaneously, able to talk in full sentences. The airway assessment is done to ensure that airway is patent (Jarvis, 2012). Mrs. Kelly’s airway was open and this assessment is usually treated as a high priority because it determines the patient’s breathing adequacy and determination of agonal respirations that may lead to death (Considine and Currey, 2015). The next assessment of breathing, Mrs. Kelly’s RR 28 breaths/min, labored with …show more content…
The patient exhibited rapid and faint peripheral pulses with HR120 bpm (tachycardia)), BP 90/50 mmHg (hypotension) and capillary refill of 4 seconds, extremities cool, clammy and molted, bilateral ankle edema and 3rd heart sound present. Documentation of carotid pulse presence but the absence of radial pulse, the patient may be experiencing cardiogenic shock. Here the poor contractibility of cardiac muscle causes stoke volume (SV) and cardiac output (CO) to decline (Elliott, Aitken & Chaboyer, 2015). Secondly the compensatory mechanism triggers renin-angiotensin-aldosterone system (RAAS) which rises catecholamine production. This action escalates antidiuretic hormone (ADH) release, which increases cardiac afterload by vasoconstriction (Wagner & Hardin-Pierce, 2014). This increases pressure on walls of the ventricle and thus affects the contractibility. The contractibility will decrease so will CO and BP, this assessment is considered a high priority in the primary assessment. The best nursing care at this stage is to keep constant monitoring of the HR, BP, SO2 and arrhythmias (Jarvis 2012). Close cardiac monitoring will aid to pick up any worsening changes. Elevated jugular venous pressure (JVP) is momentous to poor contractibility of ventricles and back flow of pulmonary vein, consequently this increases the JVP which shows fluid transporting and …show more content…
In-depth x-ray analyses are usually done so as to determine the heart size and it was normal in this case. This enables the determination of the heart size and shape because it may indicate heart failure, fluids or pericardial infusion and also problems in the heart valves (Wagner & Hardin-Pierce, 2014). Mrs. Kelly complained of severe chest pain that radiated to her neck, jaw and left arm. In this case, the x-ray analysis showed pulmonary vascular congestion and pulmonary oedema. This hence determines the likelihood of a decompensated heart failure. Furthermore, it means that the wall separating the left ventricle is not working well like the muscles around it due to ventricular failure, causing fluid buildup which leaks into interstitial and pleural space and eventually into alveoli (Croft & Gordon

Related Documents

  • Improved Essays

    Systolic Heart Failure

    • 1625 Words
    • 7 Pages

    ACE also helps with systolic heart failure. Systolic heart failure is when the ejection fraction is decreased. This leaves an unusual volume of blood in the left ventricle. This drug helps people with systolic heart failure and especially after the attack. Digoxin helps bring blood through the body.…

    • 1625 Words
    • 7 Pages
    Improved Essays
  • Decent Essays

    There are signs of crackling and with the dyspnea it is a sign that there is a lack of oxygen supply getting to his heart. This also causes fluid to build up throughout his heart causing it to pump unproductively. In Dr. Alleys case I would suggest that he has left-sided heart failure, but if not treated he can also obtain right-sided heart failure. What is happening with his eyes is also due to his hypertension which causes arteriosclerotic change. This is known as hypertensive retinopathy which is vascular affliction due to…

    • 377 Words
    • 2 Pages
    Decent Essays
  • Improved Essays

    If heart failure is left untreated the chambers of the heart dilate because of the blood left in the chamber after diastole (Lewis, et al., 2014, p. 768). Over time the heart muscle thickens due to the increased work load and thus needs more oxygen to work, causes poor contractility and coronary artery circulation (Lewis, et al., 2014, p. 768). Because this individual has a history of heart failure and triple bypass surgery we already know there is damage to his heart. Taking this medication is important for this individual to decrease his risk for further damage to his heart such as thickening of the heart muscle due to overworking of the…

    • 1405 Words
    • 6 Pages
    Improved Essays
  • Improved Essays

    Catecholomines will be activated to stabilize the cardiac output. They increase heart rate and PVR, or afterload. The renin-angiotensin-aldosterone-system will increase preload and after load. However, Angiostensin II also facilitates ventricular remodeling which will further perpetuate the problem; this can decrease cardiac contractility and cause ventricular dilation. Insulin resistance can cause extremely detrimental effects on cardiac contractility by decreasing the body’s ability to supply ATP.…

    • 782 Words
    • 4 Pages
    Improved Essays
  • Superior Essays

    Acute myocardial infarction is caused by the narrowing or the blocking of the coronary arteries that supply the heart muscle with oxygen. A myocardial infarction occurs when ischemic intracellular changes become irreversible and necrosis. The patient becomes more susceptible to another occurrence of a myocardial infarction or even lead up to heart failure. Coronary artery disease is the main cause of a myocardial infarction. Many patients that have an acute myocardial infarction often have chest pains that indicate the lack of oxygen to the heart muscle.…

    • 1337 Words
    • 6 Pages
    Superior Essays
  • Improved Essays

    Outline On Heart Failure

    • 1650 Words
    • 7 Pages

    Liver damage- right sided heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function…

    • 1650 Words
    • 7 Pages
    Improved Essays
  • Improved Essays

    If heart size is less than half of the diameter of the chest, it is determined as normal( ). Because of Patient is having STEMI, her heart contractility has decreased at the myocardum zone of ischemiac and necrosis , It is important to determine the normality size of the heart to see if there is any excessive blood or systematic fluid volume in the heart and cause heart to enlarge (). Pulmonary oedema and vascular congestion are also found on the chest xray. Myocardial infarction will cause systolic and diastolic dysfunction which makes the heart decrease its ability exchange fluid, pumonary venous pressure will then increase. The capillary hydrostatic pressure causes Pulmonary oedema and pulmonary vascular congestion.…

    • 1119 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    Airway Case Study Nursing

    • 1310 Words
    • 6 Pages

    The patient is tachypnoeic due to an increased pressure in the pulmonary veins that will lead to pulmonary congestion that lessens pulmonary compliance, which raises the respiratory rate. Also, increased blood flow in the…

    • 1310 Words
    • 6 Pages
    Improved Essays
  • Improved Essays

    One of the potential reasons for the excess risk of myocardial infarction(MI) or angina is associated with stress. In john’s condition is that stress triggers the sympathetic never systems by releasing hormones such as adrenaline and noradrenaline. Increased sympathetic activity leading to increased blood pressure levels and pulse rates. Also reduced insulin sensitivity or intolerance to glucose and increased blood clotting and blood vessel dysfunction. Reduced blood flow to the heart which resulted with increased respiratory rate.…

    • 1089 Words
    • 5 Pages
    Improved Essays
  • Superior Essays

    As cardiomyopathy worsens, the heart becomes weaker. It 's less able to pump blood through the body and maintain a normal electrical rhythm. This can lead to heart failure or irregular heartbeats called arrhythmias. In turn, heart failure can cause fluid to build up in the lungs, ankles, feet, legs, or abdomen. Role of genetics: The risk of cardiomyopathies increases when there are pre-existing genetic condition known as monogenic conditions for it.…

    • 1484 Words
    • 6 Pages
    Superior Essays