What are priority physical symptoms? What are priority emotional, psychosocial, and spiritual needs? Refer to the textbook, ELNEC program, and Blackboard readings in your response. here is 1 reading link: https://learn-us-east-1-prod-fleet01-xythos.s3.us-east-1.amazonaws.com/5e017c6ea5a61/1730235?response-content-disposition=inline%3B%20filename%2A%3DUTF-8%27%27Flaherty%252C%2520Fox%252C%2520McDonah%252C%2520%2526%2520Murphy%252C%2520Palliative%2520Care%2520Screening.pdf&response-content-type=application%2Fpdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20200221T170955Z&X-Amz-SignedHeaders=host&X-Amz-Expires=21599&X-Amz-Credential=AKIAZH6WM4PLTYPZRQMY%2F20200221%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=9e7d6a02bd96a18f737c0ef7106ab4cbdf3d40270442d34571cb6bb89355cfff
here is the case below:
Symptom Management Case Case History Jane was a 74-year-old woman with systolic dysfunction and heart failure, status post mitral valve repair (MVR) complicated by methicillin resistant s. aureus (MRSA) endocarditis, coronary artery disease (CAD) with three vessel coronary artery bypass graft (CABG) in 2002, diabetes mellitus Type 2 with sequela of neuropathy and retinopathy, and pulmonary hypertension. She was admitted from the clinic for shortness of breath. The patient reported that she did well until 2006 when she was admitted for fluid volume overload/pulmonary edema.
In May 2008, she was admitted for a non-ST segment elevation myocardial infarction (NSTEMI) with flash pulmonary edema. The patient underwent a cardiac catheterization, which demonstrated that the left anterior descending artery had an 80% proximal and 100% mid vessel occlusion. Jane was admitted three times from June to August 2008 with congestive heart failure (CHF) exacerbations. During each hospitalization, she would receive diuretics and be sent home. In May 2009, the patient decided to have surgical repair and underwent a mitral valve replacement. She had a 63-day hospital course due to complications of pulmonary edema, vancomycin-resistant enterococcus urinary tract infection, and acute renal injury. From June to November 2010, the patient was admitted three times for NSTEMI and pulmonary edema. Jane was admitted in December 2010 for volume overload and was subsequently found to have MRSA bacteremia and endocarditis. She became anuric in the setting of this infection and was started on hemodialysis. Her daughter, Ella, reported that she stopped making urine in January 2011. She was treated with a four-and-ahalf-week course of vancomycin and rifampin, but could not complete the full six-week course because of thrombocytopenia.
In the last hospitalization, the patient was doing well until she developed shortness of breath. She had a syncopal episode at home and was found down by her daughter. She quickly recovered consciousness and the paramedics brought her to the hospital. Her daughter reported that she was treated for pneumonia (vancomycin and levaquin). She was admitted for dyspnea. On admission, her weight was 67.35 kg and a brain natriuretic peptide of 21,060. In the intensive care unit (ICU), the patient had severe shortness of breath with persistent hypotension with systolic blood pressures in the 70s to 80s. She was placed on dopamine to increase her blood pressure and to attempt continuous veno-veno hemofiltration with dialysis (CVVHD) because she was hyponatremic and hyperkalemic, and her creatinine was 4.0 (previously 2.4). On day four in the hospital, the patient experienced day/night reversal (i.e., ICU psychosis) but could report that her dyspnea was a seven on a 0-10 numeric rating scale. Palliative care was consulted for symptom management and to clarify the goals of care of the patient.
Physical Examination Temperature: 36.7°C (98.1°F), pulse: 75, blood pressure: 103/68 mm Hg, respiratory rate: 20 General: Pleasantly confused woman who can follow very simple commands Eyes: Extraocular movements intact, no icterus Neck: Jugular vein distention elevated at 12 cm, neck supple Chest: Coarse lung sounds in bilateral bases, regular rate and rhythm, S1, S2, SpO 2 : 97% Abdomen: Soft, non-tender, non-distended, positive abdominojugular test, no hepatosplenomegaly Extremities: 2+ pitting edema in bilateral lower extremities, chronic venostasis changes, no rash
Diagnostics Transthoracic echocardiogram (March 2011): Normal left ventricular size with moderately reduced systolic function; segmental wall motion abnormalities are noted, estimated ejection fraction: 30% Severe tricuspid regurgitation with estimated right ventricular systolic pressure: 35 mm Hg; status post mitral valve repair with a mean gradient of 7 mm Hg (78 beats per minute) Compared to the prior transthoracic echocardiogram images on January 3, 2011, mitral valve mean gradient has decreased from 10 mm Hg, but heart rate is lower.
Chest X-ray: Stable right internal jugular dialysis catheter, sternal wires, mediastinal clips and valve prosthesis. Overall, little change with stable prominent cardiac silhouette and signs of mild-to-moderate fluid overload.