ED For Mrs. Kelly: A Case Study

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

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