nur 440 sim lab admission ticket patient name malcolm little visit 2 scenario chfsls health assessment 81 allergies penicillin
nur 440 sim lab admission ticket patient name malcolm little
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NUR 440 SIM LAB ADMISSION TICKET Patient name: Malcolm Little Visit # 2 Scenario: CHFSLS: Health Assessment 8.1 Allergies: PENICILLIN
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SIM LAB ADMISSION TICKET
Patient name: Malcolm Little
Visit # 2
Scenario: CHF
SLS: Health Assessment 8.1
Allergies: PENICILLIN
Course Objectives: By the end of the course, the student should be able to:
1. Identify competent nursing care for clients with chronic conditions utilizing evidence-based
practice guidelines (SLO 1, 2, 5).
2. Differentiate care needs of the elderly adult experiencing alterations in health (SLO 2, 3,
5).
3. Acknowledge legal and ethical issues in healthcare (SLO 3).
4. Prioritize nursing care for patients with chronic alterations in health (SLO 1, 2, 4, 5).
5. Develop an individualized teaching plan for the client with the goal of improving and
maintaining personal health (SLO 1, 2, 3, 4).
6. Correctly calculate medication doses appropriate for the population (SLO 1, 5).
THOROUGHLY ANSWER THE FOLLOWING COMPREHENSIVELY and submit by 0730 the day before
Simulation. Incomplete tickets will be returned for redo, and must be returned by the following
week’s simulation.
**ANSWERS MUST BE paraphrased AND CITE PROFESSIONAL source (Author, year, page). Textbook
and NANDA are preferred sources.
1. Paraphrase (with reference) the mechanism that occurs when LCHF causes pulmonary
edema. A) How does CHF cause pulmonary edema? Pulmonary edema is caused when
the left side of the heart/heart valve is unable to eject all of the blood out of the heart
so it accumulates in the left atrium and lungs. B) How does the fluid move from the
vessels? By the excessive fluid which causes hydrostatic pressure that causes fluid to
move from the pulmonary capillary bed into the interstitial, and then to the alveoli. C)
Where exactly is the fluid is within the lungs? The fluid builds in the alveoli in the lungs.
(Harding et al., 2020, p. 735).
2. You receive STAT orders for Furosemide and a Foley for a patient in fulminant pulmonary
edema. A) What does fulminant mean? Fulminant means acute onset (Harding et al.,
2020, p. 989). B) Based on research, how does each relieve pulmonary edema?
Furosemide is a loop diuretic and acts quickly. This diuretic works by preventing the
reabsorption of sodium (water follows sodium) at the loop of Henle. It also activates
renal prostaglandins which dilates blood vessels in the kidneys, lungs, and the body. This
action (hemodynamic effect) decreases water absorption reduces preload and central
venous pressures which in turn reduces edema (Lilley et al., 2020, p. 446). A Foley is
used to accurately monitor the total output. Low urinary output can lead to edema so
accurately monitoring it is important for a patient with HF (Harding et al., 2020, p. 739).
C) In your opinion, which intervention would you do first? I think, I would insert the
, SIM LAB ADMISSION TICKET
foley first because furosemide works quickly. I would want to closely monitor the
amount of urine that is excreted with a person who has HF. If the patient is retaining
fluids this could cause edema. Also, I would want to monitor the effects of the diuretic
and the amount of fluid lost.
3. Your patient asks how Furosemide will take the water out of his lungs and feet. In your
own words, explain this to the patient in lay terms. Furosemide is a diuretic that
prevents your kidneys from reabsorbing sodium back into the blood stream. Water
always follows sodium. When the sodium goes into your urine water will follow allowing
you to urinate the sodium and water. When you urinate this water and sodium the
pressure shifts in your vessels. This shift allows the excess water outside of your vessels
in your lungs and feet to enter your vessels and leave the body through your kidneys and
urine.
4. List six specific labs used to diagnose/assess CHF with the normal values for each
1. B-Type natriuretic peptide <100pg/mL
2. CK-MB <45-6% of total creatine kinase (CK)
3. Copeptin <10 pmol/L
4. C-reactive protein (CRP) Lowest risk: <1mg/dL Moderate risk: 1-3 mg/dL High risk:
>3mg/dL
5. Homocysteine 4-14 umol/L
6. TroponinT <0.1ng/mL Troponin I negative: <0.03ng/mL (Harding et al., 2020, p.
668).
5. Based on research, paraphrase the relationship between potassium and digoxin. Both
impact the other. A) How does hypokalemia affect digoxin levels? Hypokalemia may
signal digoxin toxicity (too much digoxin) (Lilley et al., 2020, p. 376) . Hyperkalemia
reduces the effectiveness of digoxin B) How does Digoxin toxicity affect potassium
levels? Digoxin toxicity decreases potassium levels (Lilley et al., 2020, p. 376) C) Why?
Digoxin and potassium bind to the same binding site on sodium/potassium ATPase pump.
When there is an excess in Digoxin it causes the levels to increase and bind, decreasing
potassium ability to bind (Lilley et al., 2020, p. 467) .
6. Opinion: Which IV fluid would be contraindicated in CHF. Albumin and other colloids
because they cause a shift in fluids from interstitial to intravascular spaces which makes
the heart and lungs work harder (Lilley et al., 2020, p. 446)
7. Your patient has ascites secondary to R CHF. Using paraphrase, explain how and why the
fluid moved into the abdomen. When a patient has right sided CHF, the fluid cannot fill
into the right side of the heart and backs up into the venous system. This backup of
fluids in the venous system builds in tissues and organs causing ascites in the abdomen
(Harding et al., 2020, p. 736)
8. Opinion: Why are troponins ordered for this patient? This test is ordered to see if the
patient has experienced an MI. What do troponin levels tell about his CHF??The
troponin levels tell if there is an injury or ischemia after an MI by released contractile
proteinsm (Harding et al., 2020, p. 668).
9. Create 3 nursing diagnoses using template from Simulation Materials/General
Information. Insert template into Ticket HERE.
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