Failure to Rescue - Snapshot 1

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Mary Rescueme

Case #: ABC 123

Patient History

Instructions: Review the snapshot 1 checklist and make note of what seems normal or out of range. Select submit findings after reviewing the patient's information.

New Case Information

Snapshot 1 (Admission) Checklist:

• Existing medication list
• New case information
• Resources regarding normal lab ranges
• Submit findings

Medication

Lab Ranges

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Snapshot 1

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Normal Lab Ranges

Compare Mary's lab results to normal ranges to uncover findings about the patient's case. (You can draw on this page using the pencil in the top right corner).

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The patient’s initial hemoglobin level was 10.2 g/dL, and her hematocrit was 32%.

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The patient’s initial hemoglobin level was 10.2 g/dL, and her hematocrit was 32%.

Considering her symptoms and medical history, what is the most likely underlying cause of these lab findings?

Chronic kidney disease and ongoing vaginal bleeding

The patient's comprehensive medical history and current symptoms are important to consider to make an informed diagnosis. The integration of her chronic conditions with presenting symptoms provides a clear, evidence-based rationale for selecting chronic kidney disease and ongong vaginal bleeding as the most likely underlying cause of her lab results.

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The patient's initial lab results showed a BNP level of 740 pg/mL, a serum creatinine of 1.4 mg/dL, hemoglobin of 10.2 g/dL, and hematocrit of 32%.

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The patient's initial lab results showed a BNP level of 740 pg/mL, a serum creatinine of 1.4 mg/dL, hemoglobin of 10.2 g/dL, and hematocrit of 32%.

Which combination of these lab values most significantly contributes to her diagnosis and management plan for acute heart failure?

BNP level and serum creatinine

[insert rationale for information and connection to failure to resuce]

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Considering the patient's initial presentation with dyspnea, orthopnea, and bilateral pedal edema, which underlying pathophysiological mechanism is most likely responsible for these symptoms?

Decreased cardiac output leading to fluid retention

[insert rationale for information and connection to failure to resuce]

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ChronoChart 3K

Mary Rescueme

Case #: ABC 123

Snapshot 1

New Case Information

You have discovered the following about patient Mary Rescume.

Medication & Orders

• Mary's labs show low hemoglobin and hematocrit, and her BNP signifies acute heart failure
• There is a risk of cognitive bias if focus is anchored on the heart failure and does not include an assessment of the vaginal bleeding pattern, including quality, quantity, and timing

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Resources

Snapshot 2

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Patient Name (Age: 64): Mary Rescueme DOB: February 1960

New Case information

April 12, 2024 Patient admitted to telemetry unit for medical management of heart failure exacerbation, further stabilization, fluid balance monitoring, and oxygen monitoring to optizmize her for elective hysterosocpy with dilation and curettage (D&C) for post menopausal bleeding.

Case Notes: Nurse focused on heart failure condition. Did not include assessment of vaginal bleeding pattern (quality, quantity, and timing). Summary: Cognitive bias Failure to Recognize

Initial Assessment Patient experiencing dyspnea, orthopnea, and bilateral pedal edema. Vitals: Blood pressure: 160/90 mmHg Heart rate: 110 bpm Respiratory rate: 24 breaths/min Temp: 99.0◦F Oxygen saturation of 88% on room air Diagnostics and LabsECG: sinus tachycardia | BNP 740 pg/mL | serum creatinine is 1.4 | WBC 6.5 |sodium 135 | potassium 3.9 | calcium 10.5 | hemoglobin 10.2 | hematocrit 32%

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Patient Name (Age: 64) DOB: February 1960

Patient History

Medical history Systolic heart failure, hypertension, coronary artery disease, percutaneous coronary intervention (PCI) with drug-eluting stent placement in the RCA, diabetes mellitus type 2, and chronic kidney disease stage 3. Fairly active at baseline.

March 2024 Patient exprienced progressive, debilitating fatigue, 8 kg weight gain, difficulty sleeping while lying flat, edema in both legs, and intermittent vaginal bleeding.

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Mary Rescueme Current Medications

Medications that Mary was taking at home prior to admission.

ChronoChart 3K Help

In this snapshot, we need to determine how Mary's lab results compare to normal lab ranges. Use her new case information showing vitals signs and labs. Compare to the normal lab range chart. Connect the dots to find the image and submit findings.