Cardiac Case Study Assignment | Get Paper Help
Mandatory reference:
- By Linda D. Urden, Kathleen M. Stacy and Mary E. Lough, Phd
critical care nursing, diagnosis and management, 8th edition
- (Aehlert, B. 2018. ECGs Made Easy, 6th edition
Cardiac Assignment
| Case Study Phase 1
Mrs. Singh is a 64 year old female admitted to the ICU from ED post cardiac arrest. Mrs. Singh was defibrillated X2 for ventricular fibrillation and she subsequently converted to sinus rhythm.However, Mrs. Singh remains unconscious and is now intubated and ventilated.
Past Medical History (PMH):hypertension that is controlled by medication. Current Medications: hydrochlorothiazide 25mg po daily and perindopril 2 mg po daily.
Allergies: None known
Vital Signs:B/P is 98/60, HR 70, O2 sat 94% on FIO2 .60. Cardiac monitor currently indicates sinus rhythm. Labs: cardiac troponin I (cTnI) 5.5µg/mL potassium 2.9 mmol/L other lab values are within normal range
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- Mrs. Singh’s 12 Lead ECG is seen below. Interpret this 12 Lead ECG using the systematic approach for ECG interpretation. Include the following:i)
Rhythm, ii) Axis, iii) Voltage, iv) Transition,v) BBB, vi) Hypertrophy, vii) MI location and viii) Stage of MI.(8 marks)
- During initial assessment of Mrs. Singh you notice the following rhythmon the cardiac monitor. Interpret this rhythm and discuss nursing priorities. (1 mark for interpretation; 2 marks for nursing priorities)
- What two priorityinterventions would be appropriate for Mrs. Singh post cardiac arrest (post-ventricular fibrillation)? (Total 12 marks)
Discuss the two interventions and include the following:
- Rationale for the intervention (two markseach)
- Nursing considerations for the interventions (four marks each)
| Case Study (Phase 2)
Two hours after admission, Mrs. Singh’s B/P drops to 78/50 and she has developed crackles in both lung bases. Her O2 saturation has also decreased to 88%. The intensivist/internist inserts a pulmonary artery catheter (PAC).
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- Interpret Mrs. Singh’s hemodynamic profile using the ‘grid approach’. (15 marks total)
- Analysis Mrs. Singh’s hemodynamic values (high, low or normal). (1 mark)
| Mrs. Singh’s Hemodynamic Profile
HR 56; B/P 78/50; MAP 59; PAP 39/22; Wedge 19; CVP 16; SVR 2200; PVR 250; CO 3.8; CI 2.1; LVSWI 30; RVSWI 6 |
- Examine preload, afterload, contractility and perfusion.Include the definition for each, and why each cardiac parameter would be high, low or normal in relations to Mrs. Singh’s clinical presentation and hemodynamic status. Consider how all parameters are inter-related. (8 marks)
- Briefly discuss potential causes.(2 marks)
- Explore treatment (medications and interventions) appropriate for the Mrs. Singh’s clinical presentation, the above hemodynamic parameters and your determined causes.(4 marks)
| Case Study Phase 3
Later in the shift, Mrs. Singh’s cardiac rhythm has changed and a temporary venous pacemaker is inserted in an attempt to stabilize her cardiac rhythm (noted below) and her hemodynamic status. As the nurse, you identify some issues with this pacemaker. |
- First, interpret the followingcardiac rhythm. As the nurse caring for this patient, what are the priorities for this rhythm?(1 mark for interpretation, 2 marks for nursing priorities)
- Now, atranscutaneous pacemaker is applied and the mA (milliamperes) is increased to 60. Interpret the following strip.What priority nursing actions are required?(1 mark for interpretation, 2 marks for nursing priorities)
- Your intervention is successful and Mrs. Singh is now in the following cardiac rhythm. Interpret this rhythm (1 mark).
