week2iHuman
Primary Diagnosis: Thoracic aortic dissection with branch artery involvement
Status/Condition: Critical-Guarded
Code Status: Full
Allergies: NKA
Admit to Unit: Coronary ICU
Activity Level:
...
week2iHuman
Primary Diagnosis: Thoracic aortic dissection with branch artery involvement
Status/Condition: Critical-Guarded
Code Status: Full
Allergies: NKA
Admit to Unit: Coronary ICU
Activity Level: Bedrest
Diet: Strict NPO (until evaluated by CT surgery)
IVF: 18g IVL x 2; LR@75ml/hr (monitor VS closely)
Critical Drips:
Esmolol 500 micrograms/kg intravenously initially, followed by 50 micrograms/kg/min for 4 min, may repeat loading dose and increase infusion up to 200 micrograms/kg/min in 50micrograms/kg/min increments.
Maintain SBP less than 120 and heart rate of 60–70 BPM
Nitroprusside 0.3mcg/kg/min. Titrate 0.5mcg/kg/min Q5min until SBP less than 120 (if not controlled with Esmolol)
Respiratory: O2 2L-4L via NC PRN for O2 sats less than 92%. Consult respiratory therapy for management.
Medications: (include ALL, tx of primary condition, underlying conditions, pain, comfort needs etc. dose and route)
Discontinue ASA
Hold Lisinopril 10mg PO QD until NPO discontinued
Morphine Sulfate 2-5mg IVP Q5-30 minutes PRN pain control (May consider PCA)
Nursing Orders: vital signs, skin care, toileting, ambulation etc.
Arterial line for arterial blood pressure monitoring Maintain SBP less than 120
VS: Q15min including O2 sats. Maintain heart rate 60-70. Notify MD for signs of decompensation, bleeding or respiratory failure
Continuous Telemetry monitoring
Insert foley for urinary output monitoring
Pulmonary toileting
SCDs for DVT prophylaxis
Strict Bedrest
Follow Up Lab tests : Coags (PT/Inr, PTT), Type and crossmatch, CBC, BMP, Cardiac Panel (Ck, CK-MB, Tropnonin I),
Diagnostic testing (CXR, US, 2D Echo, etc…) Include indication for test, for example CXR to evaluate pneumonia):
EKG
CXR
CT chest/abd
Consults: [Do not defer management to a specialist. As an ACNP you must manage the patient’s acute needs for at least a 24 hour period]. Include indication for consult, for example “Cardiology consult for evaluation of new-onset atrial fibrillation., or Nutrition consult for TPN recommendations.”
STAT CT surgery consult: New Type A aortic dissection
Patient Education and Health Promotion (address age appropriate patient education if applicable):
Discharge planning and required follow-up care:
References (minimum of 3, timely, that prove this plan follows current standard of care).
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