Hypovolemia Essay

388 Words2 Pages
Scenario The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at 0430 this morning. She told the ED triage nurse that he had had dysentery for the past 3 days and last night he had a lot of “dark red” diarrhea. When he became very dizzy, disoriented, and weak this morning, she decided to bring him to the hospital. C.W.’s vital signs (VS) were 70/- (systolic blood pressure [BP] 70 mm Hg, diastolic BP inaudible), 110, 20. A 16-gauge IV catheter was inserted, and a lactated Ringer’s (LR) infusion was started. The triage nurse obtained the following history from the patient and his wife. C.W. has had idiopathic dilated cardiomyopathy (IDCM) for several years. The onset was insidious, but the cardiomyopathy is now severe, as evidenced by an ejection fraction (EF) of 13% found during a recent cardiac catheterization. He experiences frequent problems with heart failure (HF) because of the cardiomyopathy. Two years ago he had a cardiac arrest that was attributed to hypokalemia. He also has a long history of hypertension (HTN) and arthritis. Fifteen years ago he had a peptic ulcer. An endoscopy showed a 25 \ 15 mm duodenal ulcer with adherent clot. The ulcer was cauterized, and C.W. was admitted to the medical intensive care unit (MICU) for treatment of his volume deficit. You are his admitting nurse. As you are making him comfortable, Mrs. W. gives you a paper sack filled with the bottles of medications he has been taking: enalapril (Vasotec) 5 mg PO bid, warfarin (Coumadin) 5 mg/day PO, digoxin 0.125 mg/day PO, KCl 20 mEq PO bid, and tolmetin (an NSAID) 400 mg PO tid. As you connect him to the cardiac monitor, you note that he is in atrial fibrillation (A-fi b). Doing a quick assessment, you find a pale man who is sleepy but arousable and oriented. He is still dizzy, hypotensive, and tachycardic. You hear S3 and S4 heart

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