opinion please

[phiposurde]

This week took care at shift chage of a patient that going to monitoring medical unit.

I didn,t really had time to take care of her since she was going up

but I have a few questions:

60-70 yrs old lady with big cardiac hx( mitral regurgitation, LV

dysfuntion, chf++

,crf with usual cr around 120 level 2. Come with SOB. Under medecine.

ABG P/F: 180, ph normal but on the low side, co2 slightly elevated ,

normal lactate and a po2 of only 72 with 40 % o2( labs from 0102 took patient at 1100). Not really in distress but sob with 2-3 words

sentence and tachypneic at 28. U/O of only 10-13 cc/h.with low 90 bp.

On report RN state rounds was done and all medecine was inform of her

condition

Here my questions:

1)wasn't she to unstable to go on the floor??

2)with such sign of shock shoudn't have receive more then the mininal

bolus she was receiving??( 250-500 x 2-3time with a NS at 50cc/h)??

3)Would a bipap would have been good in that condition, even if the

gas was normal at this time or it would have made her BP worse r/t intrathoracic pressure?

4)would our patient benefits from some physio therapy ( chest

percussion) like the ICU does??

[TazziRN, RN]

I would not have sent her to the floor unless she was a no code.

Do you want to bolus a pt who is in CHF with CRF?

Bipap...I have no idea, do not have any experience with it.

Pulmonary toilet....no idea.

[Altra, BSN, RN]

Where I work this pt. would probably have been placed on BiPAP & gone to the unit, even if only for 8 hours or so, until she hopefully improved enough to go to a monitored floor bed.

[ND76]

She would have been a unit admission at my facility, unless she was a DNR.