Perfusion Case Study Brief Patient History Mrs. K is a…

Perfusion Case Study
Brief Patient History
Mrs. K is a 58-year-old Amish American female admitted to the coronary care unit from the emergency department after an episode of ventricular tachycardia with a pulse. Mrs. K did not want to go to the hospital, verbalizing this was not needed. However, family members convinced Mrs. K to seek medical treatment because of her complaints of fatigue, palpitations, nausea, and shortness of breath for the past couple of weeks, with one syncopal episode 3 weeks ago.
Clinical Assessment
Mrs. K is restless, stoic, orthopneic, and short of breath with minimal exertion. Bilateral breath sounds are diminished with bibasilar crackles, S1, S2, S3; jugular vein distention with the head of the bed at 45 degrees; and capillary refill greater than 4 seconds, and peripheral pulses are 1+. Skin is cool, pale, and diaphoretic, and peripheral edema is noted. Amiodarone (Cordarone) is infusing IV at 1 mg/min, and a Foley catheter is draining clear amber urine at 20 mL/h. A pulmonary artery catheter is inserted with the following hemodynamic readings: right atrial pressure (RAP): 15 mm Hg; pulmonary artery pressure: 38/26 mm Hg; 25 mm Hg; cardiac output (CO): 2.8 L/min; cardiac index (CI): 1.4 L/min; and Svco2: 65%. Mrs. K has a body mass index (BMI) of 32.
Diagnostic Procedures
Mrs. K’s vital signs include blood pressure (BP) of 84/50 mm Hg, pulse of 118 beats/min that is irregular and weak, respiratory rate of 26 breaths/min, temperature of 98.2°F, and Spo2 of 90% on O2 at 4 L per nasal cannula. Electrocardiogram (ECG) reveals sinus tachycardia without ST changes; however, a Q wave ≥ 0.04 seconds and greater than 0.2 mV is evident in V1-V4, and there are occasional multifocal premature ventricular contractions (PVCs). Chest radiograph shows cardiomegaly, Kerley lines, and bilateral congestion. ECG indicates left ventricular hypertrophy with an ejection fraction of 15%. Serum cardiac enzymes are negative; serum B-type natriuretic peptide (BNP), 700 pg/mL; hematocrit, 26%; hemoglobin, 8.8 g/dL; lactate level, 3 mmol/L; white blood count, 6,000/mcL; and serum potassium, 3.8 mEq/dL. Serum glucose, 196 mg/dL; cholesterol, 350 mg/dL; triglycerides, 200 mg/dL; and high-density lipoprotein, 40 mg/dL.
Medical Diagnosis
Acute decompensated heart failure
Cardiogenic shock
Old anteroseptal myocardial infarction from ECG
There are 6 major outcomes the nurse expects to achieve for this patient. They will include:
(1) adequate tissue perfusion
(2) optimal gas exchange (O2 and CO2 exchange)
(3) optimal cardiac output and hemodynamic readings
(4) decreased cardiac workload
(5) prevention of complications from hypoperfusion and decreased cardiac output
(6) decrease in anxiety and stress.

1) Identify all the problems/risks
2) Summarize how to manage the problem/risk

3) Describe the interventions that will be initiated to monitor, prevent, manage, or eliminate the problem/risk identified

4) Explain the Afterload or this patient
references:
Preload and Afterload, Cardiac Output, Stroke Volume – SimpleNursing
NOTE: this is all the information I have for this question.