CHF Case Study
Case Study Pg 204: Essentials of Critical Care Nursing
Mrs. K., A 68 year-old white woman, has been admitted to the critical care unit with shortness of breath at rest. Vital signs are BP, 218/100 mm Hg; HR, 110 beats/min; and RR, 3 breath/min. She has run out of her antihypertensive medication for the fourth time this year and only came to the hospital because of her breathing difficulties.
On examination, Mrs. K. is pale and clammy sitting upright in a chair. She has bibasilar crackles to her scapulae, and her heart rhythm is irregularly irregular. She has pitting edema bilaterally to her thighs, jugular venous pulsation to the earlobe, and bilateral infiltrates. An ECG shows a left ventricular ejection fraction of 78% with estimated pulmonary artery pressures of 50-55 mm Hg. Laboratory values are unremarkable.
On admission, Mrs. K. is started on Lisinopril, 5 mg orally once per day, and given 20 mg of IV furosemide. She is also given 5 mg of IV metoprolol x 3 over the first 24 hours, which results in worsened shortness of breath and frothy sputum. Blood gases show hypoxemia and hypercarbia. She is intubated and placed on a ventilator. Because of her worsening condition, a pulmonary catheter is inserted. Readings are right atrial pressure (RAP) 26 mm Hg; pulmonary artery pressure 68/54 mm Hg; PAOP 36 mm Hg; and cardiac index 1.1 L/min/m2. Shortly after the readings are taken, Mrs. K. has a cardiac arrest, from which she cannot be resuscitated.
1. Mrs. K. experience fluid overload and a hypertensive emergency. What could the healthcare team have done differently in managing her hypertension and fluid overload?
a. CPAP. This would have helped “push” the fluid out of her lungs and possible increased her oxygenation. Lasix should have been increased. Only giving 20mg, in my opinion, is not sufficient enough to treat her fluid overload which is one of her major problems. Also, Calcium channel blockers should have been considered since the beta
Mrs. K., A 68 year-old white woman, has been admitted to the critical care unit with shortness of breath at rest. Vital signs are BP, 218/100 mm Hg; HR, 110 beats/min; and RR, 3 breath/min. She has run out of her antihypertensive medication for the fourth time this year and only came to the hospital because of her breathing difficulties.
On examination, Mrs. K. is pale and clammy sitting upright in a chair. She has bibasilar crackles to her scapulae, and her heart rhythm is irregularly irregular. She has pitting edema bilaterally to her thighs, jugular venous pulsation to the earlobe, and bilateral infiltrates. An ECG shows a left ventricular ejection fraction of 78% with estimated pulmonary artery pressures of 50-55 mm Hg. Laboratory values are unremarkable.
On admission, Mrs. K. is started on Lisinopril, 5 mg orally once per day, and given 20 mg of IV furosemide. She is also given 5 mg of IV metoprolol x 3 over the first 24 hours, which results in worsened shortness of breath and frothy sputum. Blood gases show hypoxemia and hypercarbia. She is intubated and placed on a ventilator. Because of her worsening condition, a pulmonary catheter is inserted. Readings are right atrial pressure (RAP) 26 mm Hg; pulmonary artery pressure 68/54 mm Hg; PAOP 36 mm Hg; and cardiac index 1.1 L/min/m2. Shortly after the readings are taken, Mrs. K. has a cardiac arrest, from which she cannot be resuscitated.
1. Mrs. K. experience fluid overload and a hypertensive emergency. What could the healthcare team have done differently in managing her hypertension and fluid overload?
a. CPAP. This would have helped “push” the fluid out of her lungs and possible increased her oxygenation. Lasix should have been increased. Only giving 20mg, in my opinion, is not sufficient enough to treat her fluid overload which is one of her major problems. Also, Calcium channel blockers should have been considered since the beta