Question

Instructions: Complete the following case study and upload it to the assignment section prior to the due date. This will contribute towards the case study portion of a student’s grade. Case study answers must be typed. Point values are assigned per question.

Patient Profile

M.W. is a 65-year-old female. She is a retired auto worker who lives in a condo with her golden retriever, Charlie. She has a history of diabetes type II diagnosed 3 years ago. She had a myocardial infarction in 2012. She does not exercise. She denies smoking or alcohol use. She was feeling fine until yesterday.

Basic Assessment Data

A&O x4, shortness of breath on exertion, fine crackles in bilateral lower lobes, O₂ saturation 89% on RA. S₁ and S₂audible without murmur, cap refill >2 secs lower extremities, <2 secs in upper extremities. Vitals: BP 100/60, HR 84, RR 28, Temp 36.1C

Ht: 5’ 5” Wt: 200 lbs.

Question #1:

(10 points) Based on these findings, what type of HF does MW have? Why?

Question #2:

(5 points) What risk factors for HF does MW have?

Question #3:

(5 points) What other manifestations of HF will you assess for?

Question #3:

(10 points) Do you believe her HF is acute or chronic? Why?

Question #4:

(15 points) What nursing diagnoses are most appropriate for MW? Name 3.

Question #5:

(10 points) What nursing diagnosis takes priority? Why?

Question #6:

(10 points) What goals do you have for MW’s care? Name 2.

Question #7:

(25 points) What interventions would you recommend for MW’s priority diagnosis? Name 5 and provide rationale for each.

Question #8:

(10 points) What would you teach MW?

Answer 1

1.left sided failure

-Because of the presence of crackles in the bilateral lower lobes,

- exertional dyspnoea

2.risk factor:lack of excercise

- type 2 DM

- passive smoker

-medical history of Myocardial infarction

3.- history of orthopnoea, cough, blood tinged sputum

- examine for cyanosis,

Confusion,

Wheeze

Pulmonary capillary wedge pressure - it will be elelevated

-Monitor

Urine Output

Oxygen saturation

Confusion, restlessness

Fluid and electrolyte imbalance

4 Nursing diagnosis:

-fatigue

- decreased cardiac output

-ineffective airway clearance

-activity intolerance

- increased fluid volume

5.- ineffective airway clearance

Because it aggravates cough, and Shortness of breath

- decreased cardiac output

Because it leads to tiredness and it can adversiely effect their daily activities

-increased fluid volume

Because it leads to accumulation of fluid in the lower love of lung leading to poor gaseous exchange and increased sputum products.

6.Goals

- maintain airway clearance

- to engage in activities that reduce workload

-to decrease the episode of dyspnoea

7.

Intervention	rationale
Elevate the bed	to decrease episode of dyspnoea
Give oxygen as indicated	to make available oxygen for gas exchange, To decrease sign of hypoxia
Administer cardiac glycosides	it improve cardiac output by improving the cardiac contractility

8.1. Educate about the patholpathology of disease

2.encourage him to take medication in proper time and in prescribed dosage

3. To have proper diabetic diet

4.teach him the importance of exercise and encourage him to do some physical activities.