38 Year Old Female Full Code No religious preferences Dx: Cardiogenic Shock Patho: Ischemia causes myocardial dysfunction which then causes the heart's ischemia to worsen which causes the heart to not function properly. It is a vicious circle and if not addressed quickly can be deadly. Hx: Heavy drug use, Fetal demise, Sepsis. Patient came to the ER experiencing chest pain and shortness of breath. She was found to have a complete block of her RCA and when they went to stent it she went into Cardiogenic Shock and had to be put on Ecmo to keep her heart functioning. Pt. was also placed on a Vent.
1 Cardiac
Stroke
Complete block of RCA
1 Continuous IV Heparin Infusion
Successful
3 Echo daily to check heart function
Successful
2 Heparin Assay drawn q6hrs to adjust dose
Successful
Meds
Zosyn 3.375mg
Lasix 40mg IV
Vancomycin IV
4 Integumentary
Weeping wounds and skin breakdown
2 Turn q2hrs
Successful
3 Protective foam patch on sacrum
Successful, but had to be change constantly due to stool incontinence.
1 Wound consult
Successful. Proper wound care developed.
3 Neurological
Stroke
1 Continuous IV Heparin Infusion
Successful. Able to maintain therapeutic level
2 Physical Therapy
Unsuccessful. Non cooperative and non compliant with evaluation.
3 Occupational Therapy
Unsuccessful. Non cooperative and non compliant with evaluation.
Meds
Fentanyl Continuous
Versed Continuous
2 Respiratory
Ventilated Patient
1 Deep suction patient as needed
Successful. Large, thick mucous removed.
2 Turn Patient q2hrs
Successful even after extubation
3 Passed ZEEP. Taken off of the vent
Successful. Patient able to breath and maintain her own airway.
5 Musculoskeletal
Stroke
3 Physical therapy
Unssucessful. Pt. non compliant and very aggressive and agitated.
2 Range of motion exercises
Unsuccessful. Pt. very agitated and aggressive. Had to be restrained otherwise rips everything out.
1 Educate the patient on her condition and how to reverse it.
Unsuccessful. Pt. verbally and physically aggressive. Not taking in the info.
Meds
Docusate 100mg
Senna
Lansoprazole 30mg