Question

Mr. Donner, age 72, is admitted to the cardiac unit for increasing dyspnea on exertion (DOE) and fatigue.

Subjective Data:

History of HF for 2 years

Unable to walk one block without increasing dyspnea

Sleep at 60-degree angle in reclining chair

Objective Data:

BP 140/78 mmHg

RR 26

HR 110

JVD @ 45 degrees

O2 91% on Room air

frequent dry cough

Bilateral crackles in lung bases

No pitting edema

10. L and R ventricular hypertrophy, bilateral fluid in lower lungs

1. Explain the cause of Mr. Donner’s fatigue, cough, and shortness of breath.
2. Which of Mr. Donner’s signs and symptoms are from left-sided HF and which are from right-sided HF?
3. Explain the purpose of each of the following therapies
   1. Furosemide (Lasix) 40 mg by mouth (PO) twice daily (BID)
   2. Benazepril (Lotensin) 10 mg PO daily
   3. 2g sodium diet
   4. Oxygen 4L/min
4. Mr. Donner suddenly becomes dyspneic and anxious and has moist crackles throughout his lungs and pink frothy sputum. O2 sats drop to 88% on 4L, RR: 27, BP 170/97, HR 125, thready, temp 100F, crackles auscultated over all lung fields. Explain what is happening. Complete the ISBARR in-class discussion form based on Mr. Donner’s current status.

5. Explain the purpose of each of the following therapies. How are they beneficial in treating Mr. Donner’s acute HF?
   1. High-Fowlers Position
   2. Oxygen 6L/min
   3. Nitroglycerin IV infusion
   4. Furosemide (Lasix) intravenous push (IVP)
   5. Morphine 2 mg IVP
6. List two priority nursing diagnosis and goals for Mr. Donner’s chronic HF.
7. What are Mr. Donner’s health learning needs to manage his condition?

Answer 1

1.In HF patients, dyspnea is thought to arise from pulmonary congestion as left ventricular dysfunction causes cardiac output to decrease and pulmonary venous pressure to rise'

The heart contracts less forcefully than it should. This can allow fluid to back up in the lungs, creating a condition called pulmonary edema. The body coughspersistently in an effort to eliminate the excess fluid.

Left-sided heart failure symptoms include:

• Awakening at night with shortness of breath.
• Shortness of breath during exercise or when lying flat.
• Chronic coughing or wheezing.
• Fatigue.
• Crackles

JVD @ 45 degrees Right sided Heart Failure

1. Furosemide (Lasix) 40 mg by mouth (PO) twice daily (BID)- Due to their greater effectiveness, loop diuretics, such as furosemide, are the mainstay of diuretic therapy in HF. Indeed loop diuretics produce more intense and shorter diuresis than thiazides, which results in more gentle and prolonged diuresis.
2. Benazepril (Lotensin) 10 mg PO daily-Benazepril is used to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Benazepril is an ACE inhibitor and works by relaxing blood vessels so that blood can flow more easily.
3. 2g sodium diet-A low-salt diet helps keep high blood pressure and swelling (also called edema) under control. It can also make breathing easier if you have heart failure.4
4. Oxygen 4L/min: During HF your heart does not pump as well as it should. So it does not send enough oxygen-rich blood to the rest of your body. Oxygen therapy increases the amount of oxygen sent to your body's tissues. This helps reduce your heart's workload.

2."ISBARR" stand for. Identify, Situation, Background, Assessment, Recommendation, Read back.

Individuals with heart failure may also exhibit moist, wet respirations, especially those suffering acute pulmonary edema, which is often associated with a frothy, pink-tinged sputum and cough.

1. High-Fowlers Position:High Fowler's position facilitates the relaxing of tension of the abdominal muscles, allowing for improved breathing.
2. Oxygen 6L/m : During HF your heart does not pump as well as it should. So it does not send enough oxygen-rich blood to the rest of your body. Oxygen therapy increases the amount of oxygen sent to your body's tissues. This helps reduce your heart's workload.
3. Nitroglycerin IV infusion :Nitroglycerin injection is used to treat hypertension (high blood pressure) to control congestive heart failure in patients who have had a heart attack. It may also be used to produce hypotension.
4. Furosemide (Lasix) intravenous push (IVP):furosemide, are the mainstay of diuretic therapy in HF. Indeed loop diuretics produce more intense and shorter diuresis than thiazides, which results in more gentle and prolonged diuresis.
5. Morphine IVP :Morphine is been used in patients with acute pulmonary oedema due to its anticipated anxiolytic and vasodilatory properties

Nursing Diagnosis:

• Excess fluid volume related disease process as evidenced by crackles and shortness of breath
• Impaired Gas Exchange related to disease process as evidenced by dysponea

Health learning needs to manage his condition

• Daily Weight Monitoring
• Monitoring decompensation signs and syndromes
• Education for the usage of medication
• Physical activity and rest