CASE STUDY

Mr Luigi is a 62 year old man with a past history of L) total hip replacement (2/12 ago), OA, angina, HT, hypercholesterolemia, emphysema and smoking.

Mr Luigi presented to hospital with hyperthermia 38.9 degrees, tachycardia 120 bpm, hypotension 90/50 and L) hip pain 8/10. Upon inspection the patient displays sweats and chills and nausea.

Q1. Describe one possible diagnosis for Mr Luigi's symptoms. Provide rationale for your diagnosis. Describe possible treatments and nursing interventions for your diagnosis.

Mr Luigi is admitted to your medical unit for treatment of his condition. As part of his treatment the registrar orders a central line to be inserted into Mr Luigi's R) sub clavian vein. The junior intern inserted the line under lax supervision. Shortly after Mr Luigi developed new symptoms including tachycardia of 150bpm, SaO2 of 88% on 10L O2 via a Hudson mask and R) sided chest pain. You perform an assessment and discover decreased breath sounds on the R) side, tracheal shift to the L) and subcutaneous emphysema on the R) side.

Q2. Describe what may be causing these symptoms. In your answer include possible diagnosis, how it may have occurred, further diagnostics, treatment options and nursing interventions.

List 5 conditions/interventions when continuous cardiac monitoring may be appropriate and provide a rationale for your choice.