Cbp on vt (1)

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Transcript of Cbp on vt (1)

Case base presentation on Ventricular tachycardia (VT)

Discuss case scenario of the patient containing past history and present complicationsDefine ventricular Tachycardia and its pathophysiologyExplain causes, sign and symptoms related to the diseaseIntegrate Diagnostic tests and lab reports of the patientLook into medical and nursing management of the patientTalk on assessment done through FHP and physical examination of the patientList down relevant nursing diagnosisDiscuss nursing interventions which were applied on the patientTalk about teaching plans which were given to the patient and his familyGive References

Reason for selecting the patientThe patient was with multiple diagnosis which was helpful for students in acquiring further knowledge and information.During interviewing and from patients file we noticed that patient is suffering from multiple diseases.Patient and his family expressed for the need of further information about the disease process.Many interventions could be taken on this patient.

A 72 year old male k/c IHD, MI (1999-s/p CABG 2000) came to AKUH ER with feeling of suffocation, exertional chest pain, heaviness and SOB for the last one day. ECG was done which showed monomorphic ventricular tachycardia with heart rate of 150/minute. He was given shocked with 100J. Baseline investigation was done and diagnosed as a case of VT, metabolic acidosis, AKI, cardiogenic shock, NSTEMI and aspiration pneumonia. When he was admitted in CCU he was intubated. A hemodialysis was done on 2/3/2016 which was tolerated well. He got extubated on 4/3/2016. Iv antibiotics were given as blood cultures showed acinobacter. Second session of hemodialysis was done on 7/3/2016 and 3rd on 8/3/2016. Patient has improved became vitally stable, maintaining respiration at RA, Patient family was so concerned due to inattentive behavior of patient against taking medicine. They wanted us to give further information about the disease process.

Past history of the patient

Ventricular tachycardiaVentricular tachycardia arises from improper electrical activity of ventricles of the heart. This is a life threatening arrhythmia because it can cause low blood pressure and may lead to ventricular fibrillation, asystole and sudden death.

Anatomy and Physiology of the heart

pathophysiology

Causes

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Sign and symptoms of VT

CEST PAIN

Shortness of Breath

PalpationsIrregular heart beating

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Dizziness

orthopnea

Fainting

Weak pulse or no pulse

Present complications of the patientnstemi

Partially blockage of coronary arteries cause reduce blood supply to the heart muscle

Cardiogenic shockShut down of vital organs due hypo perfusionAcute live failure

Due to hypo perfusion to the liver

ContinueKidney failure

Decreased cardiac outputDecreased peripheral vascular resistanceRenal artery obstruction

sepsisInfection due to low immune system and prolong hospitalizationMetabolic acidosis

Due to kidney failure

ContinueThrombocytopenia

Condition of low platelet countAspiration pneumonia

Inhalation of secretion into airwayMouth ulcer

Due to cardiac medications

Diagnostic tests

Electrocardiogram

Ecg is done in er which showed monomorphic ventricular tachycardia Rbbb (right bundle branch block)

Echocardiography

EF (Ejection fraction): 10-15% normal ef is 50-70%Mild to moderate MR (mitral regurgitation)

Cardiac enzyme testTroponin (protein) are released when the heart muscles has been damaged such as NSTEMI. The more damage the heart is, the greater amount of troponin t and I will be in blood.

Chest x-ray

B/L lower zone crepts

Right sided infiltrate

Patients lab repotsTests6/3/20167/3/20168/3/20169/3/2016NormalLevelNa 132136132132136-145K4.94.64.54.03.5-5.1NormalCl1029910599101-112BIC25.515.627.419.622-32Cr6.35.74.34.30.6-1.1Mg2.12.12.21.91.6-2.6NormalBUN738153526-20

Continuetests6/3/20167/3/20168/3/20169/3/2016NormalLevelPT14191910.99-14APTT30.9959513525-35

PLT736974109150-400WBC10.613.622.822.84-10HCT34.839.636.636.435.4-42.0NormalRBC4.154.624.163.473.9-5.5NormalHCO315.71714.815.920-31NormalCa6.57.57.59.58.6-10.2CBCINR1.91.91.91.80.8-1.1

Trop-1144144138144.130.01NG/MLPH7.347.397.347.35-7.45Normal

ABGs resultPH7.39PcO230.00PO2204.80HCO315.70SO299.6%S. Vancomycin level0.10

Ongoing monitoring BP of the PatientTime7-3-20168-3-20169-3-20167:00 am126/64mmHg97/55mmHg122/64mmHg8:00 am141/70mmHg118/66mmHg101/62mmHg9:00 am115/77mmHg112/68mmHg130/63mmHg10:00 am120/65mmHg139/68mmHg119/62mmHg11:00 am133/66mmHg113/68mmHg110/67mmHg12:00 pm122/64mmHg127/58mmHg129/73mmHg1:00 pm120/64mmHg125/69mmHg127/67mmHg

Time7-3-20168-3-20169-3-20167:00 am 64/min 66/min 62/min8:00 am 70/min 66/min 68/min9:00 am 65/min 80/min 62/min10:00 am 66/min 71/min 70/min11:00 am 73/min 69/min 73/min12:00 pm 64/min 62/min 67/min1:00 pm 55/min 66/min 64/min

Ongoing pulse monitoring

Time7-3-20168-3-20169-3-20167:00 am20/min23/min21/min8:00 am20/min18/min20/min9:00 am18/min22/min21/min10:00 am22/min19/min18/min11:00 am20/min18/min20/min12:00 pm18/min20/min19/min1:00 pm24/min20/min20/min

Ongoing monitoring respiration

Time7-3-20168-3-20169-3-20167:00 am99%97%99%8:00 am98%98%98%9:00 am97%97%96%10:00 am98%98%99%11:00 am100%97%99%12:00 pm99%96%98%1:00 pm97%98%99%

Ongoing monitoring of oxygen saturation

DatesIntake/output02/03/2016790/52 Positive03/03/20161000/37 Positive04/03/2016644/274 Positive05/03/20161344/578 Positive06/03/2016954/1200 Negative07/03/2016972/3180 Negative08/03/20161648/1370 Positive

Ongoing Monitoring Intake and output of the patient

medications

Medications

Medication

Medication

Assessment of the patient

Date07/03/201608/03/201609/03/2016Orientation (GCS)15/1515/1515/15HeadHairs: dry, black and white, equal distributed, smooth scalp, no lesions and no infestationsHairs: dry, black and white, equal distributed, smooth scalp, no lesions and no infestationsHairs: dry, black, and white, equally distributed, smooth scalp, no lesions and no infestationsEYE (pupil checked)Pupil: 3mm (PERRA), Symmetrical Eyelashes: intact Conjunctiva: pink and moistPupil: 3mm (PERRA) symmetrical, Eyelashes: intact Conjunctiva: pink and moistPupil: 3mm (PERRA), symmetrical Eyelashes: intactConjunctiva: pink and moistNoseSymmetrical, non tender, patency intact and hairySymmetrical, non tender, patency intact and hairySymmetrical, non tender, patency intact and hairy

EarHairy, wax presentHairy, wax presentHairy, wax present

MouthDry lips, buccal mucosa moist, 6 teeth absent, caries presentDry lips, buccal mucosa moist, 6 teeth absent, caries presentDry lips, buccal mucosa moist, 6 teeth absent, caries present

Date07/03/201608/03/2016NeckActive ROM, carotid pulse presentActive ROM, carotid pulse presentLymph nodePre auricularPost auricularOccipitalSubmaxillarySubmentalSuperior cervicalPosterior cervicalSupra clavicularNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpableNon tender non palpable

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Date07/03/201608/03/201609/03/2016RespiratoryAir entry bilaterally, crackle sounds are presentAir entry bilaterally, crackle sounds are presentAir entry bilaterally, crackle sounds are presentCardiacS1+S2 along with murmur soundS1+S2 along with murmur soundS1+S2 along with murmur sound

Gastro intestinalDome shape, soft abdomen, Bowel sounds present (normal)Dome shape, soft abdomen, Bowel sounds present (normal)Dome shape, soft abdomen, Bowel sounds present (normal)

Genito urinaryFoleys implanted Amber colorFoleys implanted Amber colorFoleys implanted Amber color

Skin: Color, temperature skin, turgor, integrityBrownishWarmLooseintactBrownishWarmLooseintactBrownishWarmLooseintact

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Date07/03/201608/03/201609/03/2016MusculoskeletalNo deformityNo deformityNo deformity

Bilateral vascular checkRadial+1 +1Radial+2 +2Radial+2 +2

Peripheral edemaNoNonoPain assessmentNoNoNoDrainage bagnonoNoInvasive lines20g cannula(Left hand)06/13/201620g cannula(Left hand)06/13/201620g cannula(Left hand)06/13/2016

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Functional health patterns

Patients biographic data

Name: XYZ (Male) MR# 000-00-00 Dr. Name: Fateh Ali Tepu Sultan Age: 72 years Marital status: Married Religion: Islam Language: Urdu and English Occupation: Civil Engineer Diagnosis: VT (ventricular tachycardia) Allergies: Not Known Surgeries: CABG (2000) Date of Admission: 01/03/2016

Health perception/health management pattern

General state of health (own description): sihat niyamaat he kisi insan ke pass agar sihat he to us insan ke pass sub kuch he .No medication were taken at home.Immunization status was immunized\vaccinated.Family members were well aware regarding disease process.Patient was neat, clean and well oriented to time, person and place.Patient was previously treated for CHD and CABG was done in 2000 and admitted to AKU with present complain of chest pa