Diagnosis

[Fatmah Jabr]

Hi every one,

I have a case study that I need to write about

but initially I have to diagnose the case

can any one help me to find the accurate diagnosis

since am very confused about it

Patient profile

Mrs. Edwards, a 70-year-old woman, was admitted to the medical unit with complaints of increasing dyspnoea on exertion.

Subjective data

* Had a severe myocardial infarction at 58 years of age

* Has experienced increasing dyspnoea on exertion during the last 2 years

* Recently had a respiratory tract infection, frequent cough, and oedema in legs 2 weeks ago

* Has to sleep with head elevated on three pillows

- Does not always remember to take medication

Objective data

* In respiratory distress, use of accessory muscles, respiratory rate 36 breaths/min

* Heart murmur

* Cyanotic lips and extremities

* Skin cool and diaphoretic

* Venous leg ulcer on left ankle

* Bloated abdomen

Physical examination

* Pulse full and bounding: 68 bpm, blood pressure: 122/76 mmHg

* General strength of 4/5 (80% of normal)

Diagnostic studies

* Increased white cell count (WBC 15 × 109/L); BNP normal (100pg/mL); troponin I normal (0.01 ng/mL).

* Chest X-ray results: cardiomegaly with right and left ventricular hypertrophy; fluid in lower lung fields

* Ejection fraction 25%

Collaborative care

* Digoxin 0.25 mg by mouth once daily

* Frusemide 40 mg IV twice daily

* Potassium 40 mmol/L by mouth twice daily

* Enalapril 5 mg by mouth once daily

* Low sodium diet

* Oxygen 6 L/min via Hudson mask

* Daily weights

* Daily 12-lead ECG

* Cardiac enzymes every 8 hrs × 3

[rn/writer, RN]

It helps us experienced nurses to know what you are thinking.

We don't want to rob students of the opportunity to grapple with the material and make it their own. If you share the progression of your reasoning, we know what kind of help you need. And you get the experience of supporting a rationale and integrating pieces of knowledge.

So, based on the data you have posted, what possibilities are you considering and why? And which ideas have you ruled out?

[CCL RN, RN]

Honestly? This is an orgy of information. I knew the diagnosis just from the one line patient profile, but each and every thing in your list reiterates the same thing. Think back to what you are studying right now. Look at all the symptoms as one big picture...