Case Study II


J. D. is a 67 year old female with a history of CHF. She is an ex-smoker and has committed to living a healthy lifestyle. She is careful with her diet and exercise and her goal is to be able to discontinue her cardiac medications. J.D. believes that if she can get back into shape, her body will no longer require medical intervention.

J. D. has been noticing an increase in shortness of breath when doing simple tasks around the house and also has noticed some "heart skipping". She comes to the clinic for a check up.

Physical Assessment:

Neuro: AAOx 3, moves all extremities to command, and exhibits equal strength.
Pulmonary: Exhibits shortness of breath when walking; lung auscultation reveals bilateral crackles in the bases.
GI: Bowel sounds normal; abdomen is non-tender to palpation.
GU: Clear yellow urine, no abnormalities.
CV: Pulse irregular, nailbeds pink, peripheral pulses strong. 2+ edema in lower extremities
Vitals: HR 90-95, Respiratory rate 30, BP 156/88, Temp 98.4 F, Weight 165 (note: her weight has increased by 15 lb since her last check up 1 month ago).

History: J.D. states that she discontinued her digoxin and her lasix last week because she felt like she didn’t need them any more.

Medications: Digoxin 0.125 mg PO qd
Lasix 40 mg PO qd
KCL 20mEg PO qd
Multivitamin PO qd
ASA 80mg PO qd

Diagnostic Studies:
CXR: reveals a right lower lobe pleural effusion.
Labs: Na 137, K 3.8, BUN and Creatinine normal.
EKG rhythm strip:


Questions: (IMPORTANT! See instructions below*)

1. Identify the dysrythmia
Atrial flutter
Ventricular fibrillation
Sinus arrest
Atrial fibrillation


2. What might be an appropriate treatment for J.D.?
IV digoxin and lasix
Defibrillation
Temporary pacing
Magnesium sulfate


3. Which are appropriate nursing interventions?
Teach J.D. the importance of taking her medications as prescribed.
Describe the actions of J.D.s medications to her.
Encourage J.D. to continue her diet and exercise routine.
All of the above.

4. The "hallmark" of the dysrhythmia is:
Regularity
Sawtooth baseline
Wide, bizarre QRS complexes
Irregularly irregular rhythm


5. The PR interval in the dysrhytmia is:
Prolonged
Normal
Not measurable
Shortened


The basic dysrhythmia course that is recommended as background for this Cardiac Case Studies course is the RnCeus.com course:

EKG Strip Indentification and Evaluation


*IMPORTANT!

Please write down and save your answers to the above questions. The questions will be repeated on the "Exam and Evaluation", but the scenarios and strips will not be repeated.


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