Triage Nurses and Working Diagnoses
Intro: The main goal for triage nurses when they get a call from a patient is to evaluate their symptoms and determine the level of care needed to treat those symptoms. The more pertinent information the nurse can collect, the more likely she is to understand what is causing the patients symptoms and how to assist the patient in getting to the most appropriate level of care. This nurse triage case study focuses on a cardiac patient.
When presented with a complicated patient, the nurse must review the past medical history, medication use, current symptoms and how these symptoms are affecting the patients Activity of Daily Living (ADL’s) – in other words, is this something that needs to be seen in an Emergency Room or can it wait until the patient’s physician can see them?
The Caller
Charles is a 60-year-old male who was discharged from hospital 3 days ago for an acute flare-up of his chronic condition. It is 8:30 pm and he is calling nurse triage with increased dyspnea and orthopnea. He says he hasn’t done anything different since being discharged but is still feeling very tired all day- “more than usual”. He says his shortness of breath is worse when lying flat, so he slept in his recliner last night. Charles says he has some swelling around both ankles that is new today. He also tells the nurse that he has gained 5 pounds since yesterday morning. Charles is A&O x 3.
Past Medical History: The nurse is able to ascertain that Charles had been smoking 1 pack of cigarettes a day for 20 years but quit almost 5 years ago. He rarely drinks alcohol and does not use street drugs. Charles is a supervisor at a warehouse which he tells the nurse involves some walking but most of his day is sitting behind a desk or at a work site. He lives with his wife of 40 years and has 3 grown children, all of whom are very involved and supportive to their parents. In addition to the chronic condition he is calling for tonight, Charles has a history of high blood pressure, hyperlipidemia and had a heart attack 5 years ago.
Medications: Daily medications for Charles include Lasix (diuretic), Vasotec (ACE Inhibitor), and Toprol (Beta-blocker).
Additional Information: Charles tells the nurse he has been talking with a Disease Case Manager for the last 2 years to help him manage his condition. She recommended a salt-restricted diet, restricting his fluid intake, checking his weight every day and mentioned talking to his doctor about starting a walking regime each day.
Conclusion: What is the most likely condition given Charle’s symptoms and what should be the triage disposition? Given the symptoms, there is a high probability that Charles has Congestive Heart Failure (CHF). This is a condition where the heart cannot pump enough blood to the body’s other organs. The most common symptoms are lower leg edema or dyspnea at rest or with little exertion and fatigue. CHF is diagnosed based on past medical history, physical examination, and specific laboratory tests. While there is no cure for CHF, lifestyle modifications such as reducing salt and exercising, taking medications as directed by a physician and managing stress can improve many patient’s quality of life.
