Answers to Nurse Sugar Case Study Question 3
Course Title Maternity
Case Study: Maria is a 32-year-old woman who gave birth 24 hours ago via Cesarean section under spinal anesthesia. She has a history of cardiac disease, specifically rheumatic heart disease, which has been managed with medications throughout her pregnancy. Maria is currently in the postpartum floor and you are the nurse assigned to her care.
As you enter Maria's room for routine assessment, you observe that she appears unusually pale and is breathing rapidly. She complains of feeling extremely fatigued and a bit dizzy when trying to sit up. Maria mentions that she has been experiencing chest pain since early morning, describing it as a "squeezing" sensation across her chest.
Vital Signs:
Blood Pressure: 150/95 mmHg
Heart Rate: 110 beats per minute
Respiratory Rate: 22 breaths per minute
Temperature: 37.2°C
Oxygen Saturation: 92% on room air
Recent Labs:
Hemoglobin: 10.2 g/dL
WBC: 12,000 /µL
Platelets: 180,000 /µL
Troponin: Slightly elevated
Recognizing Cues
Question: Which of the following observations should be immediately reported to the physician? Select all that apply.
- A. Elevated heart rate
- B. Complaints of chest pain
- C. Slightly elevated temperature
- D. Oxygen saturation below 95%
- E. Respiratory rate above 20 breaths per minute
- F. Pale appearance
Answers: A, B, D, F
Rationale: A: Elevated heart rate in a postpartum patient with cardiac disease can indicate decompensation or other complications. B: Chest pain is a critical symptom in cardiac patients, suggesting potential ischemia or other cardiac issues. D: An oxygen saturation below 95% in a cardiac patient indicates inadequate oxygenation, requiring immediate intervention.
F: Pale appearance may indicate anemia or worsening cardiac function, warranting immediate assessment. C: A slightly elevated temperature is common postpartum and may not be urgent unless accompanied by other signs of infection or sepsis. E: A slightly elevated respiratory rate can be due to pain or anxiety but should be monitored for further increases or additional symptoms.
Analyzing Cues
Question: Following your initial assessment, Maria reports that the chest pain worsens with exertion and slightly improves when she is resting. However, she still feels significant discomfort. You also note that her peripheral pulses are weak and her skin is cool to the touch, especially on her extremities. Her earlier reported symptoms and vital signs are adding up to a concerning picture.. What is the most likely explanation for Maria’s symptoms postpartum?
- A. Acute myocardial infarction
- B. Postpartum anxiety
- C. Pulmonary embolism
- D. Congestive heart failure
- E. Anemia from acute blood loss
- F. Musculoskeletal pain from the Cesarean delivery
Answer: D. Congestive heart failure
Rationale: The combination of worsening chest pain with exertion, weak peripheral pulses, cool extremities, elevated heart rate, and low oxygen saturation suggests a cardiac issue, likely congestive heart failure exacerbated by the stress of pregnancy and delivery.
A: While myocardial infarction is possible, the symptoms are more consistent with heart failure. B: Anxiety does not explain the physical findings such as weak pulses and cool skin. C: Pulmonary embolism could be considered given her recent surgery, but her primary symptoms and physical findings lean more towards cardiac dysfunction. E: Anemia might contribute to fatigue and paleness, but does not directly cause the specific cardiac symptoms observed. F: Musculoskeletal pain would not affect vital signs or cause weak pulses and cool extremities.
Prioritizing Hypotheses { ORDERED RESPONSE)
Question: Maria's worsening condition requires immediate intervention to prevent further complications. Given her history and the symptoms identified, you prioritize the potential complications that need immediate attention. Sequence the following potential complications in order of urgency that must be addressed based on Maria’s current status:
- A. Acute myocardial infarction
- B. Congestive heart failure
- C. Pulmonary embolism
- D. Anemia requiring transfusion
- E. Postpartum hemorrhage
- F. Postpartum infection
Ranking: B, A, C, D, F, E
Rationale:
B Immediate attention is needed for potential heart failure as indicated by her symptoms.
A: While less likely than heart failure, myocardial infarction must be ruled out quickly due to its severity.
C: Given her surgical history, pulmonary embolism remains a critical differential to rule out.
D: Anemia may need treatment but is less immediately life-threatening than cardiac or pulmonary issues.
F and E: While important, infection and hemorrhage are currently less likely given her symptoms and should be monitored but not prioritized over cardiac and pulmonary concerns.
Generating Solutions {Matrix Grid Question]
Question: You need to develop a management plan for Maria considering her likely diagnosis of congestive heart failure and other potential cardiac issues. Maria requires immediate interventions.
Match the following interventions with the conditions they primarily address. (Check the box if the intervention applies to the condition.)
Option:
1.Congestive Heart Failure
2. Pulmonary Embolism
3. Myocardial Infarction
4. Anemia
Match:
A. Administer IV furosemide
B. Administer oxygen therapy
C. Prepare for blood transfusion
D. Initiate anticoagulation therapy
Answer:
1.Congestive Heart Failure = A. Administer IV furosemide, B. Administer oxygen therapy
2. Pulmonary Embolism = B. Administer oxygen therapy, D. Initiate anticoagulation therapy
3. Myocardial Infarction = B. Administer oxygen therapy
4. Anemia = C. Prepare for blood transfusion
Rationale: Congestive Heart Failure: A. Administer IV furosemide: This intervention is indeed critical for managing congestive heart failure as it helps reduce fluid overload, alleviating symptoms like pulmonary edema. B. Administer oxygen therapy: Oxygen therapy is also appropriate here to improve oxygenation and reduce the workload on Maria's heart, helping to stabilize her condition.
Pulmonary Embolism: B. Administer oxygen therapy: Oxygen is beneficial for maintaining adequate oxygen saturation levels, particularly when pulmonary function is compromised by an embolism. D. Initiate anticoagulation therapy: This is a key intervention for managing pulmonary embolism, aiming to prevent further clot formation and potentially dissolve the existing clot, which is vital to improve Maria’s respiratory and overall physiological status. Myocardial Infarction: B. Administer oxygen therapy: Providing oxygen can help minimize myocardial injury in the event of an infarction by ensuring that the heart muscle receives enough oxygen, especially when its supply might be critically reduced. Anemia: C. Prepare for blood transfusion: This intervention is necessary for addressing anemia, particularly if it is contributing to symptomatic decline in Maria’s health by improving her hemoglobin concentration and thus oxygen-carrying capacity, which can indirectly relieve the heart's workload.
Taking Action
Question: Based on the prioritized hypotheses and the generated solutions, you must implement the interventions for Maria. Select the first three actions you would take as part of the immediate care plan for Maria:
- A. Administer IV furosemide
- B. Administer oxygen therapy
- C. Prepare for blood transfusion
- D. Initiate anticoagulation therapy
- E. Perform electrocardiogram (ECG)
- F. Monitor vital signs continuously
Actions: A, B, E
Rationale:
A: Immediate administration of IV furosemide to reduce fluid overload in congestive heart failure.
B: Oxygen therapy to manage potential hypoxia across several possible conditions.
E: An ECG is essential to rule out or confirm myocardial infarction and monitor cardiac status.
C. Prepare for blood transfusion: Although preparing for a blood transfusion is crucial for treating severe anemia, Maria's primary symptoms do not strongly suggest anemia as the immediate cause of her distress. Initial actions should focus on managing her cardiac symptoms.
D. Initiate anticoagulation therapy : Anticoagulation therapy is vital for suspected pulmonary embolism, but there is no strong indication from the scenario that Maria has a pulmonary embolism over other more apparent cardiac issues.
F. Monitor vital signs continuously : While continuously monitoring vital signs is essential in managing any critical patient, it is not an immediate intervention that would actively address the urgent needs of worsening cardiac function like administering medications or performing diagnostic tests.
Evaluating Outcomes
Question: After implementing the initial interventions, you reassess Maria to evaluate the impact of your actions and plan further care. Which of the following would be the most indicative sign that the interventions have been effective?
- A. Increased urine output
- B. Improved chest pain
- C. Stabilized heart rate
- D. Normalized blood pressure
- E. Elevated hemoglobin levels
- F. Decreased respiratory rate
Answer: C. Stabilized heart rate
Rationale: A stabilized heart rate would be a direct indicator of improved cardiac function following interventions for congestive heart failure.
A. Increased urine output: Increased urine output can be a good sign of reduced fluid overload especially after diuretic administration; however, it does not directly indicate the overall improvement of cardiac function, which is critical for Maria's immediate recovery. B. Improved chest pain: Improvement in chest pain is a positive sign but does not necessarily reflect the stabilization or overall improvement of the cardiac condition, especially in cases like congestive heart failure where other symptoms might persist or evolve. D. Normalized blood pressure: Normalized blood pressure is important, but in the context of cardiac care, it does not provide a comprehensive view of cardiac function like heart rate and rhythm stability would. E. Elevated hemoglobin levels: Elevated hemoglobin levels would indicate effective treatment of anemia if it were a primary concern, but it does not directly relate to the cardiac issues Maria is experiencing. F. Decreased respiratory rate: A decreased respiratory rate can indicate improved oxygenation and reduced respiratory distress, but it isn't the primary indicator of cardiac function recovery. It is more of a secondary parameter that improves as the primary cardiac issues are addressed.
How did you do? Did you get the answers correctly? Now, If you didn’t, there’s no need to freak out. Take time to read through the questions and answers again, it’ll train your mind on how to think critically and you’ll get better with time. Congratulations on making an attempt
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