Heart Failure Case Study Essay

Your client, Mr. color, is a 72-year-old man who called his TeleNurse Line from residence and, based on the symptoms he described, was advised to go directly to the emergency Department at his local hospital. His admitting diagnosis is exacerbation of brass tribulation (HF). His Ht is 59, Wt. 235 lbs. He secernates that his usual weight is about 220. Upon admission, his symptoms ar extreme shortness of breath unable to tole step lying tight heavy, aching feeling in his chest respirations labored 32/min. radial-ply tire pulse 108 and regular BP 150/78 color dusky and O2 sit is 82% on room air slight diaphoresis skirting(prenominal) oedema is 3+ pitting, ankle to knee bilaterally and sacral edema is also present. Bilateral BS present with coarse crackles in both(prenominal) lower lobes. He appears frightened and anxious he states, This is the worst it has of all time been please dont leave me alone.Past Medical/sociable History Coronary Artery Disease (CAD), utmost blo od pressure, cor pulmonale, emphysema-moderate stage. He smoked 2 packs per day for 35 years, and quit 5 years ago. Hospitalized 3 clock previously for HF the most recent hospitalization was 6 months ago. He is a retired insurance salesperson married and lives with his wife in a condominium. Sedentary life-style plays golf occasionally. He skipped his diuretics over the weekend be induct he was golfing.1. Which stage of the NYHA variety system and the ACC/AHA staging system would Mr. Bs symptoms best fit within? Why?I think his NYHA classification would be course of action II. He has Coronary Artery disease and frequent action at law take a leaks fatigue for him Mr. Bs ACC/AHA stage is horizontal surface D. He has been hospitalized 3 times previously for HF.2.Discuss the differences between right and left bone marrow failure, consider the pathophysiology, physiological progression, and signs and symptoms.Left Sided-The most common-Results from left ventricular dysfunction. T his prevents normal forward blood flow causing blood to cover charge up into the left atrium and pulmonary veins. Increased pulmonary pressure causes gas leakage from pulmonary capillary bed into the interstitial and then the alveoli -Manifests as pulmonary congestion and edemaRight Sided-occurs when right ventricle fails to start effectively. -Causes a backup of blood into the right atrium and venous circulation. -Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the GI tract, and peripheral edema-May also result from an acute condition such as right ventricular infarction or pulmonary embolism -Core Pulmonale can also cause right sided HF-Its primary cause is Left sided HF. Left sided HF results in pulmonary congestion and increase pressure in the blood vessels of the lungs. Eventually chronic pulmonary hypertension results in right sided hypertrophy and HF3. Mr. Blacks orders embarrass a be dside chest roentgenogram, ECG, echocardiogram, and the following labs Troponin I, CK-MB, CBC with differential, BNP, Digoxin level, Electrolytes, Mg++, ABGs, gyre and creatinine. What is the rationale for performing each of these diagnostics tests? How will the findings/information obtained from the tests be useful in managing Mr. Blacks care?Bedside chest x-rayECGTroponin I present in MIsCK-MBCBCBNP High in diligents with HFDigoxinElectrolytesMgABGBUNCreatinineMr. Black is stabilized and transferred to the cardiac Telemetry unit with the following ordersOxygen at 2-4 liters per nasal cannula to keep O2 sit down 90%Complete bed rest with HOB elevated 60-90 degrees, legs hookedSaline Lock IVFurosemide (Lasix) 80 mg I.V. push StatI&OFurosemide (Lasix) 80 mg I.V. push every 8 hr. unremarkable weight al thoerol Inhaler 2 puffs twice per dayPulse oximetry continuousK-Dur 10 mg. p.o. periodicFoley catheterASA 81 mg p.o. routineTelemetryMetoprolol atomic number 6 mg p.o. twice da ilyDiet 2 Gm Na Lisinopril 10 mg p.o. dailyFluid restriction of 1000 mL/dayHCTZ 50 mg p.o. dailyCode status Full codeDigoxin 0.25 mg p.o. daily seduce for HR 60 bpmLovenox 60mg SQ every 12 hrsDucosate sodium 100 mg p.o. daily4. Discuss the rationale for each of the orders abovePatients with HF typically have oxygenation problemsFurosemide is a loop diureticDaily Weight- water retentionPulse ox- observe O2Foley Catheter monitor output and on bed restK DurASAMetoprolol beta blocker that treats high BPLisinopril ACE inhibitor for HTNLovenox Prevents and treats clotsFluid Restriction Excess politic strains the opticDigoxin Treats rhythmic problemsDucosate Stool Softener5. Identify 3 priority treat diagnoses to include in the nursing care plan for Mr. Black.Excess fluid volumeDecreased cardiac outputImpaired gas transfigure6. What changes/assessment findings would alert the nurse that Mr. Blacks condition is deterioration?Fatigue and dyspnea continue to worsen, weight continues t o increase, edema and chest bother worsens, pleural effusion and dysrhythmias begin to develop, hepatomegaly, and renal failure begins to occurMr. Black responds well to the treatment plan and his acute symptoms resolve within 3 days. His weight returns to 220 lbs. and he is able to perform his ADLs with minimal darn and able to sleep comfortably with 2 pillows. Discharge plans are finalized.7. Which state of the NYHA miscellanea system and the ACC/AHA staging systemWould Mr. Blacks symptoms directly fit?NYHA- Class IIACCF/AHA- Stage C8. Select 2 arc topics (your choice) to focus on. Discuss what should be included in the discharge teaching plan for Mr. B. (and his wife) for each topic.Activity and rest exercise formulation can improve symptoms of HF, however Mr. B needs to understand that he will need lots of rest during and after exercise and that he shouldnt overexert himself. Teach Mr. Bs wife to monitor his exercise and encourage him to take breaks when neededDrug therapy Teach Mr. B and his wife the expected action of all his medication and how to recognize dose toxicity. Also teach him and his wife how to take a pulse rate and what range the pulse rate should be in. Teach them the symptoms of hypokalemia and hyperkalemia if diuretics are order. self-importance BP monitoring may also be appropriate in Mr. Bs situation.Heart FailureNew York Heart Association ClassificationAmerican College of Cardiology/American Heart Association Guidelines Treatment RecommendationsStage A. commonwealth at high risk of developing heart failure (HF) but without structural heart disease or symptoms of HF-Treat hypertension, lipid disorders, diabetes.-Encourage patient to stop smoking and to exercise regularly.-Discourage use of alcohol, illicit drugs.-ACE inhibitor if indicatedClass I. Patients with cardiac disease without limitations of sensible activity. Ordinary visible activity doesnt cause undue fatigue, palpitations, dyspnea, or anginous pain. Stage B. Peopl e who have structural heart disease but no symptoms of HF.-All stage A therapies-ACE inhibitor unless contraindicated-Beta-blocker unless contraindicatedClass II. Patients with cardiac disease who have slight limitations of physical activity. Theyre leisurely at rest. Ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain.Class III. Patients with cardiac disease who have marked limitation of physical activity. Theyre comfortable at rest. Less than ordinary physical activity causes fatigue, palpitations, dyspnea, or anginal pain.Stage C. People who have structural heart disease with current or priorsymptoms of heart failure. -All stage A & B therapies-Sodium-restricted diet-Diuretics-Digoxin-Avoid or withdraw antiarrhythmic agents, most atomic number 20 channel blockers, and nonsteroidal anti- inflammatory drugs.-Consider aldosterone antagonists, angiotensin receptor blockers, hydralazine, and nitrates. Class IV. Patients with cardiac disease who cant carry out any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. Any physical activity increases discomfort. Stage D. People with refractory heart failure that requires specialized interventions.-All therapies for A, B, and C-Mechanical suffice device, such as biventricular pacemaker or left ventricular helper device-Continuous inotropic therapy-Hospice careCaboral, M. & Mitchell J. (2003). New guidelines for heart failure focus on prevention. The Nurse Practitioner, 28, 22.Evaluation of EdemaFour-point scale 1+ to 4+1+ pitting barely detectable4+ pitting persistent and ambiguous (1 or 2.54 cm.)