Question

S.H. is a 25-year-old man who comes to the emergency department with chest pain radiating to the arm, behind sternum.

Subjective Data

• Character. Substernal chest pain, pressure, heaviness, or discomfort. Other sensations include a squeezing, aching, burning, choking, strangling, or cramping pain.
• Severity. Pain score of 10
• Location. Behind middle or upper third of sternum radiating to the arm.

Objective Data

• Physical Examination
• Blood pressure 189/92, pulse 120, temperature 97.7° F, respirations 22
• Labs

1.The health care provider diagnoses S.H. with CHF disease. What are the common causes of CHF disease

2.Name 2 priority nursing diagnosis for SH with 2 interventions, and 2 nursing goal with teachings.

3.S.H. is being discharged with prescriptions Inderal (Propranolol) and Nitroglycerin and recommendations to follow up with his primary care physician in 3-4 days.

4.What should your discharge teaching for S.H. include?

Answer 1

Answer-

1. Causes of CHF disease :

• Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits (plaque) in your arteries, which reduce blood flow and can lead to heart attack.

• High blood pressure (hypertension). If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff or too weak to effectively pump blood.

• Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve — due to a heart defect, coronary artery disease or heart infection — forces your heart to work harder, which can weaken it over time.

• Damage to the heart muscle (cardiomyopathy). Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy. Genetic factors also can play a role.

• Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus, including COVID-19, and can lead to left-sided heart failure.

• Heart defects you're born with (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which, in turn, may lead to heart failure.

• Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, creating extra work for your heart. A slow heartbeat also may lead to heart failure.

• Other diseases. Chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis) — also may contribute to heart failure.

  Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

2. Nursing Diagnosis: Decreased Cardiac Output related to increased preload and afterload and impaired contractility as evidenced by irregular heartbeat, dyspnea upon exertion, and fatigue.

Nursing interventions include promoting activity and reducing fatigue to relieve the symptoms of fluid overload.

4. Discharge teaching :

• Take your medicine as directed.

• Do not smoke. ...
• Do not drink alcohol or use illegal drugs. ...
• Eat heart-healthy foods and limit sodium (salt). ...
• Manage any chronic health conditions you have. ...
• Drink liquids as directed. ...
• Maintain a healthy weight. ...
• Stay active. ...
• Weigh yourself every morning.