Ms. J. is obese and the extra weight pushing against her lungs can make her feel even more short of breath sitting her up in high fowlers will assist with her chest expansion.

Ms. J. is obese and the extra weight pushing against her lungs can make her feel even more short of breath sitting her up in high fowlers will assist with her chest expansion.

Ms. J. is obese and the extra weight pushing against her lungs can make her feel even more short of breath sitting her up in high fowlers will assist with her chest expansion. She definitely feels like she cannot catch her breath, and this causes anxiety for anyone who feels like they are gasping for air which she is. Ms. J needs continuous cardiac monitoring, O2 monitoring, blood pressure monitoring, frequent assessments with reassessments, oxygen therapy, lab work to be drawn. With the monitoring systems available in the units and ERs we can monitor her BP every 5 minutes or even more frequently. Morphine could be used and help her settle a little and not panic, in attempt to decrease her elevated respiratory rate, but it may drop her blood pressure further. Lasix will pull some of the fluid off of her lungs, but what is her kidney function and can she eliminate this extra fluid? Lasix can also lower blood pressure but in her clinical presentation it is more important to alleviate the fluid build up in her lungs than risk a very insignificant possible drop in her blood pressure. She has COPD considering her History with sleep apnea and an 80 pack year history. The Metoprolol may help with the heart rate, but this too could affect the blood pressure(BP) and cause it to drop lower. Vasotec I would hold this because her BP cannot tolerate it, unless more aggressive interventions are taken. Considering she will be in an ICU we could use Dopamine gtt. or Levophed gtt. if we needed to aggressively get her heart rate down with another blocking agent given IV, without compromising her BP and system perfusion. This is when we need to consider what is her mean arterial pressure(MAP) is she perfusing…? I would hope that by the time she got up to the ICU she had some form of O2 therapy in place, she most likely needs a breathing treatment also and possible BiPap if the O2 via nasal cannula is not helping at 6 LPM. All of this depends are her clinical presentation and vital signs.

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