Guidance with care plan..please

[ekka]

Hi....looking for guidance

My patient is an 81 yr old female, presented to er with SOB,

She has pneumonia, copd, pacemaker, HTN,

Showing NSR....did have non sustaining runs of SVT throughout night...but none now

B/P has been 180/84, now running 155/71

HR has been between 111 and 102 throughout the day

I was told she is more confused today than yesterday, she was often paranoid, has not slept at all, and has complained that she is hyperventilating.

I was thinking

Decreased cardiac output r/t altered heart rate AEB complaints of SOB

and

Impaired gas exchange r/t decreased surface area available for gas exchange AEB tachycardia, increased confusion and restlessness

any advice, input appreciated.....thank you!!

[nursej22, MSN, RN]

I am not sure you have enough evidence to demonstrate decreased cardiac output. CO is stroke volume x HR, and you have not stated any measure of that. This is usually measured in an ICU.

Do you have another measure of say...oxygenation?

Is she comfortable?

[SiADH135, ADN]

If you're going to do cardiac output focus on perfusion, distal pulses, mucous membranes, skin color and temp, organ perfusion (kidneys: urine output, BUN, CR), do you know her ejection fraction? cap refill, idk I'm just throwing things out there.

Impaired Gas for sure, but AEB would be low O2 sats (altered LOC ), SOB, maybe crackles or lung sounds, sputum from the PNA, cough, inc. HR

Hope this helps!

[nursej22, MSN, RN]

There actually is a diagnosis for decreased tissue perfusion, which I think would be more correct than decreased cardiac output.

[amoLucia]

I see safety issues r/t increased confusion, paranoia & sleep deprivation.

Is a pulse ox reading avail?

I'm a biggie re safety after you clear out all the ABCDs.