Mr Maxwell is a 67-year-old man who was admitted to the ward through the emergency department following an anterior ST elevation myocardial infarction. He is confused, BP 100/55, heart rate 115, Sinus Tachycardia on the monitor, respiratory rate 24, sweating, peripherally cold, is complaining of feeling nauseous and he has not passed urine for 6 hours. The emergency team have asked that he be monitored closely. He has an infusion of Dobutamine running. A urinary catheter has been inserted. HBS107 Understanding Health
He is receiving oxygen at 25% via a venturi mask
Mr Maxwell has Arterial Blood gas results as follows:
pH 7.35 PaO2 89, PCO2 45, Lactate 3.19.
Mr Maxwell has a past history of smoking for the past 35 years (20 cigarettes a day) he stopped smoking 5 years ago. He is a non-insulin dependent diabetic (NIDDM) managed with Gliclazide SR. He has had some abnormal blood tests in the past 6 months and is seeing an endocrinologist. He thinks his kidneys are not working properly.
Mr Maxwell is accompanied by his wife of 40 years The cardiology registrar has suggested an intra-aortic balloon pump may be required and that Mr Maxwell should be transferred to a tertiary hospital for further supportive management. HBS107 Understanding Health
Identify and Describe the two most likely complications Mr Maxwell may be developing after his acute Myocardial Infarction. Please indicate which complication is the higher priority and the rationale for this decision.
For the nominated highest priority complication in question 1, please describe the nursing care and medical management that Mr Maxwell requires over the next 24 hours. Please indicate the frequency of repeated interventions.
Outline your plan of care to prepare Mr Maxwell for transfer by road ambulance accompanied by a medical officer. He is travelling 40 minutes to a major tertiary hospital. Please address patient preparation specific to Mr Maxwell, including physical and psychosocial requirements as well as logistic considerations for safe transfer of this patient
Mrs Maxwell asks you about her husband’s kidneys and urine output which has been low since the catheter was inserted. Please describe how you will answer Mrs Maxwell when she asks you about her husband’s risks for acute kidney injury. HBS107 Understanding Health