The patient is admitted to the telemetry floor for diabetic ketoacidosis and becomes your patient. The patient has been started on IV fluids and an insulin drip. After 8 hours of being under your care the patient complains of increasing shortness of breath and believes her swelling of lower extremities is worsening. You obtain vital signs:
Vital Signs: T: 99.8; HR: 110; R: 32; B/P: 172/98; O2 sat: 90% on 2 Liters O2 per NC
Stat labs and chest x-ray are obtained, and an echocardiogram and EKG have been ordered.
Na 134 mEq/L K 5.1 mEq/L Cl 109 mEq/L HCO3 17 mEq/L BUN 44 mg/dL Cr 1.5 mg/dL
Glucose 180 WBC 12.7 x 103/mm3 Hb 13.6 g/dl / Hct43%
BNP: 1025pg/ml patient Troponin I, High Sens: 15
CXR: Cardiomegaly with pulmonary venous hypertension. Evidence of mild pleural effusion. No consolidation or atelectasis noted
ECHO = EF(ejection fraction) = 38% EKG = Sinus tachycardia with rare PVCs
Answer the following questions based on the information above:
6)The patient is noted to be in congestive heart failure. What lab results and diagnostic tests support this diagnosis? (3 points)
7) What are the contributing factors for CHF noted in the patient history (2 points) and assessment findings noted in the physical exam (2 points) that contribute and/ or relate to this diagnosis? (hint: see H&P from week 1).
8) The patient is a known hypertensive on medication, but her blood pressure continues to rise. Name three early compensatory mechanisms occurring in heart failure and the expected effect in compensation (6 points)
