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62 yo Female DNAR/+ETT Allergies: keppra, zofran, dilantin…
62 yo
Female
DNAR/+ETT
Allergies: keppra,
zofran, dilantin
Medical DX:
Prosthetic valve infective endocarditis with septic shock
Bioprosthetic aortic, tricuspid, and mitral valves
Severe rheumatic heart disease
Permanent Atrial Fibrillation
Acute decompensated HF with preserved ejection fraction
Hemolytic anemia
Pulmonary HTN
Hepatopathy r/t HF
Cerebrellar intracranial + subdural hemorrhage
Prosthetic aortic valve stenosis
Prosthetic mitral valve regurgitation
Tricuspid valve stenosis and incompetence
Anorexia
DOE
Medications
Aspirin
Salicylate
Cardivascular hx + stroke prevention
Cefazolin in dextrose
Antibiotic
Prosthetic valve infective endocarditis
Lidocaine patch
anesthetic
pain relief
Enoxaparin
Anticoag. LMWH
Prophylatic. Elevated D-dimer
Heparin lock flush
Anticoag.
Patent PICC
Famotidine
H2 receptor blocker
Decrease gastric acid
Furosemide
loop diuretic
CHF, HTN, + pulm. HTN
Magnesium oxide
Supplement
Oxymetazoline sol.
Nasal congestion
Potassium chloride
supplement
Imaging
EKG 6/29/18: Atrial Fibrillation
with premature ventricular or aberrantly
conducted complexes. Septal infarct
vent. rate 69 bpm
Chest xray 6/18/18:
Adequate placement of R PICC
No pneumothorax. CHF
Chest CT 6/29/18:
No evidence of PE
Small alveolar consolidation at R.posterior
lung base. Chronic lung disease
Cardiomegaly
Mitral, tricuspid, and aortic valve replacements
Liver cirrhosis
TEE 6/8/18: L. vent. ejection fraction 45-50%
R. vent. moderately increased. low-normal systolic function
Labs
RBC L, Hgb L, Hct L, Lymphocytes L, Monocytes H,
D-Dimer H, PTT H, Creatinine H, GFR L, Albumin L,
C-Reactive protein H
Troponin H
Possible NDX
Decreased CO r/t CHF, AFib,
endocarditis and prosthetic valves
Fatigue r/t anemia + decreased CO
Ineffective health management
Excess fluid volume r/t CHF