sandra
Forum Guru
Topics: 180
Posts: 426
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A 57-year-old woman has had progressive shortness of breath over the past 2 days. The
woman was admitted to the medical service 6 days ago after a fall and has been on bed rest
for a nondisplaced pubic ramus fracture. She has been on deep vein thrombosis prophylaxis
with subcutaneous heparin. Her past medical history is significant for type 2 diabetes and
dialysis-dependent renal failure secondary to diabetic nephropathy. She makes no urine at
baseline. Her last dialysis run was 4 days ago, though she usually undergoes dialysis 3 times
per week. She has no chest pain. On physical examination, she appears anxious. Her blood
pressure is 160/105 mm Hg, pulse is 110/min, and respirations are 22/min. Her oxygen
saturation is 80% on room air, and she appears cyanotic. She has a jugular venous pressure
of 10 cm and inspiratory crackles half way up from the bases on auscultation of the lungs. An
electrocardiogram reveals a rate-related right bundle branch block but no ischemic changes. A
chest x-ray film obtained yesterday revealed interstitial edema and vascular redistribution to
the apices. Which of the following is the most appropriate initial therapy?
A.
[font face="Arial"]
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An anti-hypertensive agent to decrease her blood pressure to normal
B.
A beta blocker to better control her pulse
C.
Intravenous morphine to decrease her respirations to normal
D.
Oxygen by endotracheal intubation to maximize the oxygen concentration
E.
[font face="Arial"]what does she have?
[/font]Oxygen by face mask to increase her oxygen saturation
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| Korotkoff
Forum Senior
Topics: 14
Posts: 164
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E
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| dr_arc
Forum Senior
Topics: 5
Posts: 156
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pt in heart failure .hasnt been dialysed as per her ususal schedule. she is backing up her fluids.
next thing to do- O2 by mask.
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