Heart Failure Case Study Essay

Your client, Mr. Black, is a 72-year-old man who called his TeleNurse Line from home and, based on the symptoms he described, was advised to go directly to the Emergency Department at his local hospital. His admitting diagnosis is exacerbation of heart ill luck (HF). His Ht is 59, Wt. 235 lbs. He states that his usual weight is about 220. Upon admission, his symptoms are extreme shortness of breath unable to tolerate lying flat heavy, aching feeling in his titty respirations labored 32/min. radial pulse 108 and regular BP 150/78 color dusky and O2 Sat is 82% on room air push aside diaphoresis skirting(prenominal) edema is 3+ pitting, ankle to knee bilaterally and sacral edema is as well as present. Bilateral BS present with coarse crackles in both lower lobes. He appears frightened and anxious he states, This is the worst it has ever been please dont leave me alone.Past Medical/ friendly History Coronary Artery Disease (CAD), hypertension, cor pulmonale, emphysema-moderate sta ge. He smoked 2 packs per day for 35 years, and quit 5 years ago. Hospitalized 3 times previously for HF the most recent hospitalization was 6 months ago. He is a retired insurance salesperson married and lives with his wife in a condominium. Sedentary life style plays golf occasionally. He skipped his diuretics over the weekend beca mathematical function he was golfing.1. Which stage of the NYHA classification system and the ACC/AHA staging system would Mr. Bs symptoms best fit within? Why?I think his NYHA classification would be Class II. He has Coronary Artery unhealthiness and ordinary activity causes fatigue for him Mr. Bs ACC/AHA stage is level D. He has been hospitalized 3 times previously for HF.2.Discuss the differences between right and left heart reverse, consider the pathophysiology, physiological progression, and signs and symptoms.Left Sided-The most park-Results from left ventricular dysfunction. This prevents normal forward personal credit line flow causing b lood to back up into the left atrium and pulmonary veins. Increased pulmonary stuff causes eloquent leakage from pulmonary capillary bed into the interstitial and then the alveoli -Manifests as pulmonary congestion and edemaRight Sided-occurs when right ventricle fails to centralize effectively. -Causes a backup of blood into the right atrium and venous circulation. -Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the GI tract, and peripheral edema-May also result from an acute condition such as right ventricular infarction or pulmonary embolism -Core Pulmonale can also cause right sided HF-Its primary cause is Left sided HF. Left sided HF results in pulmonary congestion and increased pressure in the blood vessels of the lungs. Eventually chronic pulmonary hypertension results in right sided hypertrophy and HF3. Mr. Blacks orders include a bedside chest x-ray, ECG, echocardiogram, and the follo wing labs Troponin I, CK-MB, blood profile with differential, BNP, Digoxin level, Electrolytes, Mg++, ABGs, BUN and creatinine. What is the rule for performing each of these diagnostics tests? How will the findings/information obtained from the tests be useful in managing Mr. Blacks solicitude?Bedside chest x-rayECGTroponin I present in MIsCK-MBCBCBNP High in patients with HFDigoxinElectrolytesMgABGBUNCreatinineMr. Black is alter and transferred to the Cardiac Telemetry unit with the following ordersOxygen at 2-4 liters per nasal cannula to keep O2 Sat 90%Complete bed easing with HOB elevated 60-90 degrees, legs reliantSaline Lock IVFurosemide (Lasix) 80 mg I.V. push StatI&OFurosemide (Lasix) 80 mg I.V. push every 8 hr.Daily weight Albuterol inhalator 2 puffs twice per dayPulse oximetry continuousK-Dur 10 mg. p.o. dailyFoley catheterASA 81 mg p.o. dailyTelemetryMetoprolol 100 mg p.o. twice dailyDiet 2 Gm Na Lisinopril 10 mg p.o. dailyFluid restriction of 1000 mL/dayHCTZ 50 m g p.o. dailyCode stance Full codeDigoxin 0.25 mg p.o. daily Hold for HR 60 bpmLovenox 60mg SQ every 12 hrsDucosate sodium 100 mg p.o. daily4. Discuss the rationale for each of the orders abovePatients with HF typically have oxygenation problemsFurosemide is a loop diureticDaily Weight- water retentionPulse ox- reminder O2Foley Catheter monitor output and on bed restK DurASAMetoprolol beta blocker that treats high BPLisinopril ACE inhibitor for HTNLovenox Prevents and treats clotsFluid Restriction Excess peregrine strains the heartDigoxin Treats rhythmic problemsDucosate Stool Softener5. Identify 3 priority nursing diagnoses to include in the nursing care plan for Mr. Black.Excess fluid volumeDecreased cardiac outputImpaired gas exchange6. What changes/assessment findings would alert the nurse that Mr. Blacks condition is worsening? bore and dyspnea continue to worsen, weight continues to increase, edema and chest pain worsens, pleural effusion and dysrhythmias begin to develop, hepatomegaly, and renal failure begins to occurMr. Black responds well to the give-and-take plan and his acute symptoms resolve within 3 days. His weight returns to 220 lbs. and he is able to perform his ADLs with minimal SOB and able to sleep substantially with 2 pillows. Discharge plans are finalized.7. Which state of the NYHA Classification system and the ACC/AHA staging systemWould Mr. Blacks symptoms now fit?NYHA- Class IIACCF/AHA- Stage C8. Select 2 discharge topics (your choice) to focus on. Discuss what should be included in the discharge teaching plan for Mr. B. (and his wife) for each topic.Activity and rest make training can improve symptoms of HF, however Mr. B needs to understand that he will need lots of rest during and after exercise and that he shouldnt overexert himself. Teach Mr. Bs wife to monitor his exercise and encourage him to take breaks when neededDrug therapy Teach Mr. B and his wife the expected action of all his medication and how to recognize drug tox icity. Also teach him and his wife how to take a pulse rate and what float the pulse rate should be in. Teach them the symptoms of hypokalemia and hyperkalemia if diuretics are order. Self BP monitoring may also be appropriate in Mr. Bs situation. heart FailureNew York Heart Association ClassificationAmerican College of Cardiology/American Heart Association Guidelines Treatment RecommendationsStage A. pile at high luck of developing heart failure (HF) but without structural heart disease or symptoms of HF-Treat hypertension, lipid disorders, diabetes.-Encourage patient to stop smoking and to exercise regularly.-Discourage use of alcohol, illicit drugs.-ACE inhibitor if indicatedClass I. Patients with cardiac disease without limitations of corporeal activity. Ordinary physical activity doesnt cause undue fatigue, palpitations, dyspnea, or anginal pain. Stage B. People who have structural heart disease but no symptoms of HF.-All stage A therapies-ACE inhibitor unless contraindicate d-Beta-blocker unless contraindicatedClass II. Patients with cardiac disease who have slight limitations of physical activity. Theyre comfortable at rest. Ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain.Class III. Patients with cardiac disease who have marked limitation of physical activity. Theyre comfortable at rest. Less than ordinary physical activity causes fatigue, palpitations, dyspnea, or anginal pain.Stage C. People who have structural heart disease with current or priorsymptoms of heart failure. -All stage A & B therapies-Sodium-restricted diet-Diuretics-Digoxin-Avoid or withdraw antiarrhythmic agents, most calcium channel blockers, and nonsteroid anti- inflammatory drugs.-Consider aldosterone antagonists, angiotensin receptor blockers, hydralazine, and nitrates. Class IV. Patients with cardiac disease who cant carry out any physical activity without discomfort. Symptoms of cardiac deficiency or of the anginal syndrome may be present even at rest. Any physical activity increases discomfort. Stage D. People with refractory heart failure that requires specialized interventions.-All therapies for A, B, and C-Mechanical assist device, such as biventricular pacemaker or left ventricular assist device-Continuous inotropic therapy-Hospice careCaboral, M. & Mitchell J. (2003). New guidelines for heart failure focus on prevention. The Nurse Practitioner, 28, 22.Evaluation of EdemaFour-point scale 1+ to 4+1+ pitting barely detectable4+ pitting long-lasting and deep (1 or 2.54 cm.)