NUR 4052 Case Study #2 (Lecture)
A 73 y/o female patient with PMH significant for remote tobacco abuse, COPD on home oxygen (2L NC), hypertension, hyperlipidemia, and DM type II is brought to the ED by EMS after a wellness check by her family. The patient was found on her bedroom floor after an unwitnessed fall, and estimates that she was down for approximately 6hrs. She is awake and alert, reporting no pain or decreased ROM after her fall. She reports nausea and vomiting for approximately 3-4hrs prior to her fall. Her exam is significant for hypotension (85/40) and the presence of pathologic Q waves in her inferior leads (II, III, aVF). base on this case study answer these questions :
1.) What initial information is essential to obtain from the patient/ family/ EMS in order to provide excellent care to this patient?
2.) Given the patient’s EKG findings, what is your leading differential diagnosis for her shock? What are other potential differentials?
3.) What in your patient’s PMH may predispose her to an atypical presentation of myocardial ischemia?
4.) What further diagnostic testing should the RN advocate for in order to effectively manage this patient?