Heart Failure Case Study (45 min)
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Outline
Mr. Jones, a 69-year old male, presents to the Emergency Department (ED) after visiting his primary physician complaining of general fatigue for 4 days, shortness of breath, and abdominal discomfort. Mr. Jones’s medical history includes hypertension and coronary artery disease. He had a previous 90% LAD blockage and 50% RCA blockage with stent placements in both.
What initial nursing assessments need to be performed for Mr. Jones?
What diagnostic tests do you anticipate being ordered by the provider?
Upon further assessment, the patient has crackles bilaterally and tachycardia. A chest X-ray shows cardiomegaly and bilateral pulmonary edema. An ECG revealed atrial fibrillation. His vital signs were as follows:
BP 150/72 mmHg Urine Yellow and Cloudy
HR 102-123 bpm and irregular BUN 17 mg/dL
RR 24-32 bpm Cr 1.2 mg/dL
Temp 37.3°C H/H 11.8 g/dL / 36.2%
Ht 175 cm LDH 705 U/L
Wt 79 kg ** BNP 843 pg/mL
Mr. Jones was admitted to the cardiac telemetry unit.
Mr. Jones states that this weight is approximately 3 kg more than it was 3 days ago.
What is the significance of Mr. Jones' weight gain?
What medications do you anticipate the provider ordering for Mr. Jones? Why?
About three hours after admission to the telemetry unit, Mr. Jones’s skin becomes cool and clammy. His respirations are labored and he is complaining of abdominal pain. Upon physical examination, Mr. Jones is diaphoretic and gasping for air, with jugular venous distension, bilateral crackles, and an expiratory wheeze. His SpO2 is 88% on room air and it was noted that his urine output had been approximately 20 mL/hr since admission. His BP is 190/100 mmHg, HR 130 bpm and irregular, RR 43 bpm.
What nursing interventions should you perform right away for Mr. Jones?
Describe what is happening to Mr. Jones physiologically.
What medications should be given to decrease Mr. Jones’s preload? Improve his contractility? Decrease his afterload?
Mr. Jones was transferred to the CCU for hemodynamic monitoring and aggressive therapy. His Central Venous Pressure (CVP) was found to be 19 mmHg, Cardiac Output was 4.5 L/min, Cardiac Index was 2.3 L/min/m2. He has been placed in high-fowler’s position, and his SpO2 is now 96% on 4L nasal cannula. Mr. Jones received Furosemide 80 mg IV and Digoxin 0.5 mg IV.
What is the expected outcome of administration of Furosemide? Digoxin?
References
Melander, S. (2004). Case studies in critical care nursing: A guide for application and review, 3rd ed. Philadelphia, PA: Saunders Elsevier.
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Medical surgical 1 (Cardiac and respiratory)
Concepts Covered:
- Cardiac Disorders
- Emergency Care of the Cardiac Patient
- Cardiovascular
- Shock
- Shock
- Noninfectious Respiratory Disorder
- Respiratory
- Acute & Chronic Renal Disorders
- Hematologic Disorders
- Respiratory Emergencies
- Documentation and Communication
- Preoperative Nursing
- Immunological Disorders
- Intraoperative Nursing
- Vascular Disorders
- Renal Disorders
- Disorders of Pancreas
- Newborn Complications
- Medication Administration
- Central Nervous System Disorders – Brain
- Studying
- Emergency Care of the Trauma Patient
- Infectious Respiratory Disorder
- Endocrine
- Disorders of the Adrenal Gland
- Disorders of the Thyroid & Parathyroid Glands
- Musculoskeletal Trauma
- Oncology Disorders
- Integumentary Disorders
- Integumentary Disorders
- Liver & Gallbladder Disorders
- Circulatory System
- Disorders of Thermoregulation
- Multisystem
- Upper GI Disorders
- Neurological Emergencies
- Communication
- Perioperative Nursing Roles
- Sexually Transmitted Infections
- Peripheral Nervous System Disorders
- Disorders of the Posterior Pituitary Gland
- Lower GI Disorders
- Postoperative Nursing
- Emergency Care of the Respiratory Patient
- Emergency Care of the Neurological Patient
- Respiratory Disorders
- Respiratory System
- Infectious Disease Disorders