新西兰代写作业:肺纤维化

2018-03-01 16:44

该患者被诊断为肺纤维化，呼吸短促，伴有吸气、心房纤颤和尿中MRSA的诊断。病人的其他病史包括慢性肾病、家庭缺氧和射血分数低。有了这个说法，这个病人发生了几件事，但正在接受抗生素和心脏的治疗来控制心房纤颤。在半夜，病人对低血压的反应很快，并转移到重症监护室。因为先前的回声显示病人的EF只有12%，所以大的液体boluses并不是治疗低血压的真正的选择。低血压是由几个不同的原因引起的，在med surg的护士给了这个病人多种血压药物，而重症监护医生觉得她的表现很严重。同时，重症监护医生也认为病人需要进行一个统计VQ扫描来排除肺栓塞的可能性。病人的结论是，肺栓塞的可能性很高，这使得病人被放置在肝素静脉，她的腿有静脉超声和回声。这些测试检查了她的腿和心脏没有凝块。使用肝素，将PT/INR绘制为基线，然后每6小时画一个hep xa，直到肝素具有治疗作用。一个BNP和CBC被吸引来监测血细胞计数和一个中心线，病人被放置在Levophed，以防止低血压几个小时。几个小时后，病人就可以不用药物控制血压。抗生素继续作为患者WBC的14000和病人在ICU连续监测几天。CVP的测量值为5，尿量受到密切监测。
新西兰代写作业:肺纤维化
This patient was admitted to a medical surgical unit with the diagnosis of pulmonary fibrosis, shortness of breath and pain with inspiration, atrial fibrillation and MRSA in the urine. Patient’s other history included chronic kidney disease, oxygen dependent at home and a low ejection fraction. With this being said, this patient had several things happening, but was being treated with antibiotics and Cardizem to control A-Fib. In the middle of the night, the patient was a rapid response for hypotension and moved to the intensive care. Because of a previous echo that revealed the patient’s EF was only 12%, large fluid boluses were not really an option to treat hypotension. The hypotension was caused by a few different reasons, the nurse in med surg had given this patient multiple blood pressure medications, and the critical care doctor felt that she was becoming septic due to her presentation. Also, the critical care doctor decided that the patient needed a stat VQ scan to rule out the possibility of a pulmonary embolism. The patient results concluded that there was a high probability of a pulmonary embolism which warranted the patient to be placed on IV heparin, have a venous ultrasound of her legs and an echo. These tests reviewed no clots in her legs or heart.With heparin, a PT/INR was drawn for baseline and then a hep xa was drawn every 6 hours until the heparin was therapeutic. A BNP and CBC were drawn to monitor blood cell counts and a central line was placed and the patient was placed on Levophed to prevent hypotension for a few hours. After a few hours, the patient was able to keep blood pressure controlled without medications. Antibiotics were continued as patients WBC’s were 14000 and the patient was continuously monitored in the ICU for a few days. CVP’s were measured at 5 and urine output was monitored closely.

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