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PLEASE READ THE CASE STUDY AND ANSWER THE QUESTIONS TO THE BEST OF YOUR ABILITY: Mr....

PLEASE READ THE CASE STUDY AND ANSWER THE QUESTIONS TO THE BEST OF YOUR ABILITY:

Mr. Jackson is 86 years old. He is admitted to HUMC for congested heart failure. He also has a history of renal failure and goes for dialysis on Mondays, Wednesdays and Friday. He has an AV fistula in his right hand. He also has a history of diabetes, hypertension and depression.

He is allergic to shrimp. He is a nonsmoker. He lives with his wife and two sons.

He is on a renal, low sodium, low cholesterol diet.

He is positive for clostridium difficile.

He suffered a stroke while he was in the hospital and now has left sided weakness.

9. After you have identified possible complications for Mr. Jackson list nursing outcomes or interventions that would be included in his plan of care?

Solutions

Expert Solution

CONGESTIVE HEART FAILURE

Possible complications

  • cardiac cachexia - it is the unintentional rapid weight loss
  • Congestion [ fluid buildup ] - as he is also a known case of renal failure there will be fluid buildup in the lungs and the extremities
  • Arrhythmias - irregular beating of the heart
  • angina and heart attack
  • fatigue and weakness
  • shortness of breath
  • weight gain and fluid retention
  • weezing or cough
  • loss of muscle mass
  • pulmonary edema
  • sleep apnea

Plan of care

1. decreased cardiac output related to generalized weakness and alterations in rate, rhythm, electrical conduction.

desired out comes

  • patient will report decreased episodes of dyspea, angina
  • will demonstrate adequate cardiac output evidenced by vital signs with in normal limits

interventions

  • ascultate epical pulse, assess heart rate, rhythm.
  • note heart sounds
  • palpate peripheral pulses [ do not take pulse from right hand because the av fistula is present ]
  • monitor blood pressure [do not take bp on right hand due to presence of av fistula ]
  • inspect skin for pallor, cyanosis
  • monitor urine output, noting decreased output and concentrated urine
  • note changes in sensorium; lethary, confusion, disorientation, anxiety and depression
  • assess mental status and consciousness
  • monitor oxygen saturation and ABG

2. impaired gas exchange related to alveolar edema due to elevated ventricular pressure as evidenced by shortness of breath

  • assess the vital signs
  • administer supplimental oxygen, as prescribed. discontinue if SPO2 level is above the target range or as ordered by the physician
  • encourage samm and frequent diets
  • elevate the head end of the bed. assist the patient to assume semi fowlers position

Nightingale answered 1 year ago
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