Myocardial infarctions

Admitted to the hospital; with chest pain, dyspnea, and worsening peripheral edema.  has hx of 2 myocardial infarctions. has early signs of vacular dementia and is oriented x2 but does not know the current date. patient is incontinent of urine but continent of still. patients get laxatives in the and evening toileting.

As you prepare to complete your admission assessment all three children are pacing in the halls.

patient has a DNR in place.

Initial impressions:

The patient is slumped forward in bed which is in fowler’s position. she is pale and diaphoretic and her eyes dart around the room when you enter. She utters a moan and you observed her breathing is rapid and noisy with obvious use of the sternocleidomastoid and abdominal muscles. Her hair is dishevelled and you notice a sunken appearance around her mouth. you cannot see any teeth when she speaks. her voice is soft and she speaks slowly.

Both legs are edematous with +4 pitting to the knees. Edema is also present above the knees but it is non-pitting. Both lower legs are covered in gauze cling dressings that are soaked through with serous drainage. Her feet are swollen and have a dusky grey color. You are not able to palpate the pedal pulse.

There is an edematous area on her coccyx. no redness noted at this time.

Height 157cm

weight 57 kg wt 2 days ago was 54kg

BP 92/60

HR 62

RR 28

O2 sats 86%on RA

Lab results

FBG 5.6 mmol/L

Hgb 110 g/L

Troponin I- negative for MI

Diagnostics

Admits to ACE unit

VS q4h

Daily weight

Bed rest with BRP

Increase activity as tolerated

Intake and output

Fluid restriction of 1L/24 hr

Dressing changes to lower legs BID or PRN

Cardiac diet

Salt restriction

Digoxin 0.125 mcg once daily

Enalapril 2.5mg PO BID

Aspirin 81mg once dailyu

Furosemide 80mg PO at HS

Furosemide 40mg PO at HS

Bowel protocol- begin with day 2 of protocol

Lorazepam 0.5mg SL Q4H PRN