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 S₂ audible 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

MW have Left -sided heart failure because in left side heart failure causes pulmonary congestion this will leads to dyspnea,pulmonary crackles,low oxygen saturation levels.

MW may develope crackles advancing to all lung fields,and cough with large quantities of frothy sputum,which is some times pink(blood- tinged).Progression of heart failure leads altered digestion,dizziness,confusion,anxiety.She may also have risk for developing inadequate tissue perfusion, diabetes mellitus type 2 is also contributing to this.Orthopnea,paroxysmal nocturnal dyspnea, tachypnea can happen to her.

Now she have fatigue,and tachypnea(morethan20breaths/min).She is in an acute stage because the symptoms are treatable, these are initial symptoms.

Activity intolerance and fatigue related to decreased CO and poor oxygen saturation level due to impaired tissue filling,anxiety related to breathlessness from inadequate oxygenation,ineffective therapeutic regimen management related to lack of knoeledge are the nursing diagnosis.

Priority nursing diagnosis is anxiety related to breathlessness from inadequate oxygenation.Because she is having increased respiratory rate and low oxygen saturation level.

Major goals for this patient includes promote activity and reduce fatigue,relieve fluid overload symptoms,decresing anxiety,promote self care.

Promoting activity tolerance for that,monitor patient's response to activities, assess health status,instruct patient to avoid prolong bed rest, encourage to do exercises because sedentary life style worsen the symptoms. Reduce fatigue by collaborate with patient to develop a schedule that promotes pacing and prioritization of activities.Help patient to develop positive outlook focused on strength and interests.Position patient or teach her to assume a position that facilitates breathing.Controll anxiety by administering oxygen in acute stage.

Teach patient self-care and continuing care.Provide patient education and involve patient in implementing the therapeutic regimen to promote and understanding the complaince.Consider plan according to cultural factors.Support patient and family and encourage to ask questions.Assess the physical environment of patient.Encourage her to fill with positive thoughts in mind always.Develope a diabetic teaching plan to prebvent complications includes caloric requirements and self-administration of insulin.Promte her to maintain hygienic practices in her lifestyle.