Brief Patient History
Mr. K is a 58-year-old white man admitted to the cardiac unit from the medical unit after cardiac arrest (VF). He was successfully defibrillated after one shock (biphasic at 200 joules). He has a history of hypertension, myocardial infarction, mitral valve regurgitation, atrial fibrillation, and hyperlipidemia. Mr. K was scheduled for mitral valve replacement and the maze procedure. Mr. K is a school administrator, is married, and has two daughters who live out of state.
Clinical Assessment
Mr. K is awake; follows commands; and is oriented to person, place, and time; however, he complains of weakness and severe shortness of breath despite sitting upright in bed.
Procedures
Mr. K’s vital signs include blood pressure of 142/82 mm Hg, pulse of 168 beats/min that is irregular and bounding, respiratory rate of 28 breaths/min, temperature of 98.2F, and SpO2 of 92% on O2 at 2 L per nasal cannula. Further assessment reveals bilateral breath sounds with coarse crackles in the bases, S3, and a loud pansystolic murmur. Cardiac rhythm is atrial fibrillation. Chest radiograph shows cardiomegaly and bilateral congestion. Echocardiogram indicates left ventricular hypertrophy with an EF of 25%. He has negative serum cardiac enzymes; serum B-type natriuretic peptide (BNP), 1100 pg/mL; serum potassium, 3.8 mEq/dL; cholesterol, 250 mg/dL; triglycerides, 200 mg/dL; and high-density lipoprotein, 30 mg/dL.
Medical Diagnosis
- • Atrial fibrillation with a rapid ventricular rate
- • Heart failure
- • Mitral valve regurgitation
Questions
1. What major outcomes do you expect to achieve for this patient?
2. What problems or risks must be managed to achieve these outcomes?
3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
4. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
5. What possible learning needs would you anticipate for this patient?
6. What cultural and age-related factors may have a bearing on the patient’s plan of care?
