60 yr old male dx with renal failure and recent hospitalization for atrial fib and stage 3 ulceration

Came in at 0430, increased SOB and weakness, BP 80/62, RR 30, HR 164, AFib.Gave 1000ml
bolus NS to increase BP. Was in hospital for Afib and stage 3 ulcer. Takes at home antibiotics.
PMH CRF, DM2, PVD, CAD, and A-fib. Hx of 1 pack cigs/day, 3-5 alcoholic drinks/wk. Difficulty
with diabetic management plan. Labs are Na 128, K 5.1, BUN 44, Cr 0.6, WBC 16.1

SBAR

Nurse checks foot looks for antibx

1. Apply clean gloves.

2. Remove dressing and place in moisture-proof bag.
3. Remove clean gloves.
4. Wash hands.
5. Apply sterile gloves.
6. Cover with sterile gauze.
7. Secure dressing.

O2 still 88%, cant take deep breaths, nurse has him sit up more to no avail, she calls Dr over

Furesomide 20 mg IV

He feels better, voided 50 mL, double check K levels in 2 hrs and reduce O2 sincefrom 85 to
95%

I chose to obtain a bladder scan.

I chose the bladder area NOT the umbilicus area

He has scant amount of urine in bladder, HR more irregular, he has SOB, 1230 labs K is 6.0,
BUN is 52, creatinine is 3.6, has elevated T wave, HR is 140, Dr holds vancomycin cuz of
decreased kidney fx, NUrse picks up anotehr pt and is also requested to check on another pt
with chest pain

Ofc check on the chest pain and assign someone else to attend the bed alarm!

She give Mrs.Brown Nitroglycerin, waits for a few minutes until pain subsides

She checks on Mr Jones and he feels hot and sick and nauseous, his heart’s beating faster as
charge tells nurse to check on lead placement

Chose Focused Assessment

Chose Call RRT because of sustained V-Tach

SOB, weakness, pneumonia in RULobe, 1500 V tach, took Amiodarone 150 mg, IV bolus, over
10 min, he is in A-fib now with R 100 baseline. Medical Hx: chronic renal failure, peripheral
vascular dx, type 2 diabetes, stage 3 ulceration on R foot

Chose Kayexalate, from kidney dx and high potassium

NO sleep, bone tired, HR improved, K is elevated with his kidney dx, diarrhea to get rid of
potassium, just keep the commode close by haha

Wants to get back into bed, 2 large bowel movements, not as tough to breathe, K at 5.0. 250 mL
of dark urine, Dr says give him 40 mg furesomide, and recheck electrolyte labs

Chose 2.5 mL

Dr Grassler comes to talk about dialysis she is nephrologist

EAT LESS PROTEIN

NO more hamburgers and steaks, K is at 4.8, he urinated a lot, his IV site hurts, says he has
bad veins, need new IV for antibx

Chose Remove IV catheter

Dr Kindlebrook wants to install a central line (PICC)

Chose Use a sterile technique to change the dressing, Obtain consent before central line
placement, Change the catheter cap every 3 to 7 days

Setup home health svc, reports that he came in with SOB, weakness, and a-fib, past medical hx
includes chornic renal failure, type 2 diabetes, peripheral vascular dx, coronary artery dx, and
atrial fibrillation, requires at home IV antibx tx

I chose R: Upon discharge, Mr. Jones is scheduled to receive cefepime 2 g IV daily for the next
2 weeks.

Mr. Jones is doing better, Nurse checks PICC line, no pain, no redness no drainage, and
dressing is clean, no questions, set up home health visits, next does of IV antibx is due next
morning. Pt wants foot to heal, and home health will contact him to set up appointments