Question

Case Study: Congestive Heart Failure

Directions for completion: Student to answer each question in their own words using 2-3 sentences for each question. If using a text book to assist with answers, place the name of the text and page number in the content of the question.

Patient Profile

Mrs. E., a 70-year-old Hispanic woman, was admitted to the medical unit with complaints of increasing dyspnea on exertion.

Subjective Data

· Had a severe MI at 58 years of age

· Has experienced increasing dyspnea on exertion during the last 2 years

· Recently had a respiratory tract infection, frequent cough, and edema in legs 2 weeks ago

· Cannot walk two blocks without getting short of breath

· Has to sleep with head elevated on three pillows

· Does not always remember to take medication

Objective Data

Physical Examination

· In respiratory distress, use of accessory muscles, respiratory rate 36 breaths/min

· Heart murmur

· Moist crackles in both lungs

· Cyanotic lips and extremities

· Skin cool and diaphoretic

Diagnostic Studies

· Chest x-ray results: cardiomegaly with right and left ventricular hypertrophy; fluid in lower lung fields

Collaborative Care

· Digoxin 0.25 mg PO qd

· Furosemide (Lasix) 40 mg IV bid

· Potassium 40 mEq PO bid

· Enalapril (Vasotec) 5 mg PO qd

· 2 g sodium diet

· Oxygen 6 L/min

· Daily weights

· Daily 12-lead ECG, cardiac enzymes q8hr x 3

Critical Thinking Questions

1. Explain the pathophysiology of Mrs. E.’s heart disease and include the RAAS system.

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2. What clinical manifestations of heart failure did Mrs. E. exhibit? Name seven

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3. What is the significance of the findings of the chest x-ray?

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4. Explain the rationale for each of the medical orders prescribed for Mrs. E.

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5. What are appropriate nursing interventions for Mrs. E.? Name 7.

6. What teaching measures should be instituted to prevent recurrence of an acute episode of heart failure? Name 3

7. Based on the assessment data presented, write two or more appropriate nursing diagnoses along with the related to and AEB.

8. Are there any collaborative problems? Name 2

Answer 1

1-In heart failure heart may not provide tissues with adequate blood for metabolic needs and cardiac related elevation of pulmonary or systic venous preassures may result in organ congestion.In heart failure with low cardiac out put state,activation of the RAAS serves as a compensatory mechanism to maintain cardiac output.Reduced renal blood flow and sodium delivery to the distal tubule leads to renin release which is exacerbated further by increassed sympathetic tone.

2- The symptoms of Heart failure present in the patient is

• Shortness of breath
• swelling in the legs
• Reduced ability to excerise
• Persistent cough
• Sudden ,severe shortness of breath
• Chest pain
• Odema on the abdomen.

3- Here the patient having Cardiomegaly,and ventricular hypertrophy anf fluid filled in the both lungs.

Cardiomegaly can cause by many conditions,including hypertension,coronary artery disease,infections.Right ventricular hypertrophy is usually caused by problemm in lung,but left ventricular hypertrophy occurs as a result of problem with aortic valve.Here also fluid present in the lungs,it leasds to difficulty in breathing.Understanding the facts are very important to get a diagnosis and treat the disese at earlier.

4-

Digoxin 0.25 mg PO qd

· Furosemide (Lasix) 40 mg IV bid

· Potassium 40 mEq PO bid

· Enalapril (Vasotec) 5 mg PO qd

· 2 g sodium diet

· Oxygen 6 L/min

· Daily weights

· Daily 12-lead ECG, cardiac enzymes q8hr x 3

4-

Digoxin 0.25 mg PO qd

· Furosemide (Lasix) 40 mg IV bid

· Potassium 40 mEq PO bid

· Enalapril (Vasotec) 5 mg PO qd

· 2 g sodium diet

· Oxygen 6 L/min

· Daily weights

· Daily 12-lead ECG, cardiac enzymes q8hr x 3

4- Digoxin 0.25 - If the patient experincing the symptoms of Heart failure ,Digoxin can improve the heart 's ability to pump blood.This will often improves shortness of breath.

Furosemide- This is a Diuretic used to reduce extar fluid in the body caused by conditions such as Heart failure,liver disease,Kidney disease.This can reduse the symptoms of shortness of breath and swelling in the extrimities and abdomen.

Pottassium - Pottassium supplements is given to the patient to maintaion the pottassium level in the body,A severe pottassium defficiency can cause breathing difficulties.This is because pottassium helps relay signals that stimulate the lungs to contract and expand .When pottassium level are severly low the lungs may not expand and contract properly.This results in shortness of breath.

Enalapril-This will reduce the severity of Heart failureand symptoms of shortness of breath and tirdness

Sodium diet 2gm- Reducing the amount of sodium may help to reduce the blood preassure.Sodium makes the body hold on to fluid.To pump the added fluid the heart has to work harder.Too much salt can wrosen symptoms like swellin and shortness of breath and cause weight again.

Adult should eat 6gm of salt in a day,here it is restricted to 2gm per day.

Oxygen 6l/min- To maintain the airway oxygen administration is needed,oxygen therapy can help to decrease the shortness of breath.In heart failure the heart does not pump as effectievely as it should not meet the need of the body,Oxygen therapy helps compensate by increassing the amount of oxygen delivered to the body.

Daily weightIn heart failure first alerted sign is weight gain more than two or three pounds in a 24 hour or more than five pounds in a week.Weight can give a accurate idea of sudden changes.

Daily ECG- ECG or EKG to assess the rate and rhytham.This helps to identify diseases of heart,enlargement of heart,and if fluid present in lungs.Here it helps to understand the patient condition better.

Cardiac enzymes Every eight hourly- cardiac enzymes can elevate in cardimyopathy,infections and other heart conditions,Hense it will helps to identify the condition bette.

5- Immediate management is needed for this patient ,Ceratin interventions are

• Place the patient in comfortable position,High fowlers position is adequate to reduce the pulmonary congestion,and releive odema.
• Administer oxygen in high concentrations by mask to improve gas exchange and pulmonary function.
• Prepare for intubation,and ventilator support if required.
• Suction the fluid as needed to maintain the airway .
• Provide reasuurance.
• Insert Foleys catherter if advised to monitor the intake and out put ,
• Avoid administration of fluid.
• Assess the patient for complications,
• Administer medications as orderd.

6- We can prevent the severity of Heart failure by ceartain mesures.

Reduce the risk factors,Monitor and observe the patient ,Contine mecication as prescribed.

7-There are several problems related with heart failure.

Decressed cardiac out put -Ineffective tissue perfusion related to decreassed cardiacoutput.

Excessive fluid volume,-

activity intolerance

,impaired gas exchange,

8-