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Patient presented to the emergency department with a chief complaint of feeling weak, tired, and lethargic. The patient states, "I've just been feeling run down and I don't know why." She also states that she is currently on diuretics and has a history of type I DM, HTN, and stage 3 chronic kidney disease. According to her caregiver and family, she has had difficulty breathing on minimal exertion and constantly appears "winded" even at rest. She reports that she is currently unable to ambulate and has been feeling lethargic for three days. According to her family, since her discharge from the hospital one month ago her respiratory status has not returned to normal. She also reports having a history of muscle cramping in her lower leg, but currently there is none present. She has been using 2L of oxygen via nasal cannula and just a few days ago her Lasix dose was doubled to help manage her CHF symptoms. She reports her quality of life has significantly declined in the last month and she now requires 24 hour assistance.
On examination: The patient appears to be AAOx3, with no focal neurologic deficit. She appears to be cachectic, and in respiratory distress. Pulses in the lower extremity were diminished bilaterally. Patient shows reliance of use with her accessory muscles to assist with breathing and has difficulty completing her sentences. Her vitals are the following: HR115, RR 26, BP 88/42, SpO2 89% on room air. There is an, audible S1 and S2 on auscultation.
Lab work showed the following results:
- serum potassium: 2.1mEq/L and
- Magnesium 1.1mEq/L. Upon palpation abdomen was soft and non-distended.
Questions:
1. Differentiate and list subjective versus objective data.
2. List, in order of importance, the top three priorities we should focus on with this patient.
3. List five nursing interventions that address your top priority for this patient. Please provide a rationale for your interventions.
4. What would you focus your education on for this patient? Please explain your answer.
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