心髒科 護理案例請教 - 趣味新聞網

1.依案例选五项支持医生诊断为 Acute Heart Failure的理由
你的个案中..病人CXR的data是....?
pleural effusion?cardiomegaly?lung edma?pneumonia?
你只写  "显示 白色班片"
病人有pitting edema吗?
EKG data是..?
抽血data除了Na K glu.
那cardio enzyme?
那urine output是多少?
underline disease有什么疾病吗?

S3
SpO2 90% 挂6L 氧气面罩
唿吸不过来 说话都很简短 之间都要停下唿吸才可继续说完一句
睡觉要垫2-3个枕头帮助唿吸
唿吸速率 每分26次 很吃力 有杂音 哮鸣 与 湿音

以上是我猜的...有空研究研究再回来^^

2# Ting0214

感谢您的回应
我真的很希望能给您更多资料
可惜题目提示只有这么多 以下是题目原文 (希望不是我翻译错误造成您无法帮我判读)^_^"
Case Study
You are the graduate nurse working in a cardiac medical ward of a public
hospital. Mrs Slaughter, a 63 year old female, is admitted to your ward with a
history of acute anterior myocardial infarction one month ago and smoking one
pack per day until she quit smoking two years ago. Following the myocardial
infarction she was prescribed aspirin, clopidogrel and perindopril. Mrs Slaughter
has become increasingly weak over the last week and has been unable to do any
light housework.

On admission to the ward Mrs Slaughter presented as follows:
Glasgow Coma Scale  15
Heart rate   96-112 beats/minute and irregularly irregular
o Heart sounds: S1 and S2 audible with S3 also heard   
Blood pressure 115/60 mmHg
Respiratory rate 26 breaths/minute and laboured
o Wheezing and crackles over both mid and lower lung fields were
auscultated.
SpO2   90% on 6 Litres oxygen/minute via Hudson mask
Temperature 37.20 Celsius  
Skin   clammy and cool
Height  160 cm
Weight  82 kilograms.
CXR   white patchy areas throughout both lung fields with               
Kerly B lines
Mrs Slaughter also complains of:
Heaviness in her chest on and off for the last few days but denies any
discomfort now.  
Shortness of breath. She speaks in short sentences and pauses to catch
her breath. She says she needs 2 or 3 pillows to sleep on to help her
breathe at night.
Cough which sometimes keeps her up at night.  

Laboratory data
Na+  135 mmol/L
K+  4.2 mmol/L
Glucose 7.8 mmol/L

Mrs Slaughter was diagnosed by the resident doctor with a acute heart failure.

QUESTION 1:
From the case study above, select five (5) key pieces of assessment data that
support a diagnosis of acute heart failure. Explain how/why this data presents in
heart failure.  

QUESTION 2:  
Discuss three (3) priority interventions to implement over the next 6 hours for
this patient to manage the problem/s identified from the assessment data. Your
answer must at a minimum:
indicate which aspects are nursing responsibilities and which are the
responsibilities of other disciplines e.g. medicine, physiotherapy
include an explanation for why or how the intervention would improve the
problem/s.
For each intervention you have selected, outline two (2) specific evaluation
criteria that would indicate to you, the nurse that this patient’s problem/s is
improved or resolved.  

Monitoring/observations will NOT be accepted as an intervention.

2# Ting0214


我找到Kerley lines are a sign seen on chest radiographs with interstitial pulmonary edema

They are suggestive for the diagnosis of congestive heart failure

Kerley B lines
These are short parallel lines at the lung periphery. These lines represent interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs.

我想这是诊断要素之一

3# badecat


感谢回答 您说的全都正确 果然是有经验的前辈 ^_^

整个无言.....
我只是猜猜耶
不过既然是case study就应该把资料一个一个分开研究一下啰
我有个问题是为什么你的CASE STUDY是英文的 ?
你读哪个学校阿@@?

7# badecat

国外大护二年级每週作业 上看到的案例

其实案例已经给了足够资讯做诊断

这些案例台湾护士不需要学吗??

不觉得是运气 你应该从经验里猜的吧??

哪来的经验@"@
我只是刚好学到这部分而已
你那个case study很像我现在桌上这一份作业啰
而且也习惯了国外问题的问法
不过我还是猜的....因为我是坏小孩作业还没写~_~"

在美国是一定要学这些病例的 虽然并非强制规定
因为RN必须预想医生会作何处置而有所准备 也要写护士诊断书
台湾的体制比较依赖医生诊断 所以我也不知道你需不需要耶
也许就像你说的 累积经验对于这些病例应该有很大的帮助吧

何種工作最適閤你?

兩鼻孔交換呼吸 做四次能助眠、降血壓？

中國菸槍不減反增 戒煙率僅14.4％

《時報周刊》堅叔瞭望台─決定自己的醫療處置

1/60PG天使的支架...

前一篇新聞

心髒的問題,請醫師或護理人員不吝賜教

后一篇新聞

心髒節律與音樂同步