Heart Failure Case Study (45 min)
Included In This Lesson
Study Tools For Heart Failure Case Study (45 min)
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.
22 Jan – 28 Feb
Concepts Covered:
- Cardiovascular
- Circulatory System
- Nervous System
- Skeletal System
- Emergency Care of the Cardiac Patient
- Neurological
- Respiratory
- Urinary System
- Respiratory System
- Endocrine System
- Studying
- Tissues and Glands
- Medication Administration
- Hematologic System
- Digestive System
- Reproductive System
- Endocrine and Metabolic Disorders
- Muscular System
- Sensory System
- Basics of Human Biology
- Prefixes
- Suffixes
- Fetal Development
- Terminology
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Preoperative Nursing
- Integumentary Disorders
- Urinary Disorders
- Noninfectious Respiratory Disorder
- Cardiac Disorders
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Central Nervous System Disorders – Brain
- Hematologic Disorders
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Legal and Ethical Issues
- Factors Influencing Community Health
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Vascular Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Gastrointestinal Disorders
- Newborn Complications
- Peripheral Nervous System Disorders
- Communication
- Microbiology
- Emergency Care of the Trauma Patient
- Integumentary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Postoperative Nursing
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Fundamentals of Emergency Nursing
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Emergency Care of the Neurological Patient
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Respiratory Disorders
- Infectious Disease Disorders
- EENT Disorders
- Emergency Care of the Respiratory Patient
- Adult
- Anxiety Disorders
- Depressive Disorders
- Dosage Calculations
- Understanding Society
- Concepts of Pharmacology
- Newborn Care
- Adulthood Growth and Development
- Pregnancy Risks
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts