Med-Surg Care Plan Help

[Jill2Shay]

Our first care plan for block 2 is a case study. We have three pathos to write. Two are obvious and one requires a bit of critical thinking and I want to know if my thinking is sound. I've emailed my instructor but she won't give me a straight answer.

Very quickly...

Pt has CHF, history of MI, chronic A-fib, and a CXR shows infiltrates in the lower lobes, bilaterally. C/o SOB and and dizziness.

Obviously I wrote pathos on the CHF and A-fib...

Is my thinking correct in that the lung infiltrates are indicative of pulmonary edema r/t the CHF and A-fib?

I've read that lots of things can cause infiltrates, usually infections, but his labs show a normal WBC level.

I just started block 2 two days ago! This is due Friday! Talk about hitting the ground running!

[nurseprnRN, BSN, RN]

Your thinking is correct. How and why do infiltrates develop in the setting of CHF? Note that infiltrates aren't necessarily infection-based, so WBCs may not be elevated.

[Jill2Shay]

Thanks! I read that infiltrates can be caused by any number of things, one of which being CHF. His WBC count was normal, so I'm going to pick pulmonary edema as my third patho to write up.

Then I get to intertwine them! Whheeee!

[Esme12, ASN, BSN, RN]

but the chest x-ray say infiltrates...not pulmonary edema. What is the pathophys for a MI? Did the damage caused by his MI cause the A Fib and CHF? Did this patient has any invasive intervention? Where was the MI? What area of the heart was affected?

[Jill2Shay]

None of that was included in the case study. It just said history of MI three years ago, CHF exacerbation and chronic A-fib.

I was told to use critical thinking to figure out a third patho to do.

There were no invasive interventions listed. Just a 12-lead EKG which showed the A-fib and a CXR that showed the infiltrates. His WBC count was normal.

Would it be safe to assume (I hate that word) that the infiltrates in the lower lobes are caused by pulmonary edema r/t the CHF and A-fib? Considering his labs showed no indication for any other issue?

[MendedHeart]

Why did this patient have an MI? Coronary Artery Disease or hyperlipidemia?

[Esme12, ASN, BSN, RN]

None of that was included in the case study. It just said history of MI three years ago, CHF exacerbation and chronic A-fib.

I was told to use critical thinking to figure out a third patho to do.

There were no invasive interventions listed. Just a 12-lead EKG which showed the A-fib and a CXR that showed the infiltrates. His WBC count was normal.

Would it be safe to assume (I hate that word) that the infiltrates in the lower lobes are caused by pulmonary edema r/t the CHF and A-fib? Considering his labs showed no indication for any other issue?

Still they had an MI...what are the causes of MI? Why did they have an MI what is a MI? Just becasue a patient has CHF infiltrates doesn't mean they have Pulmonary edema.

If the patient has CHF where id they get the CHF? what weakened the muscle? You are trying to fit the patient into evidence. Let that go. Look at what the patient has and complains about...the CHF had to start for some reason....right? What would that reason be? A damaged heart muscle from an MI? What are this patients cardiac labs? what is his BNP....what other information do you have about this patient?

What about this patient dizziness? What could that be caused from? epsides of rapid A fib? Volume issues (excessive diuresis?)? Pump Issues (hypotension from pump failure)? Hypoxia due to p[ump failure and fluid excess?

What do you think?

[Jill2Shay]

I had TOTALLY misread what my insturctor had written about the third patho!

I asked if the MI was the third patho even though it was 3 years previous and an isolated incident.

She said (I thought) You need to use critical thinking to figure out what the third patho is.

What she really meant was use critical thinking to figure out why the MI is important.

It was worded in a different way, of course, and I was totally confused!

I did end up doing the MI as the third patho, and it was incredible interesting!