Medical Case Study: The Patient with Heart Failure
The Patient with Heart Failuure
74-year-old woman is admitted to the hospital with heart failure. She had been growing progressively weaker and had ankle edema, dyspnea on exertion, and three-pillow orthopnea. On admission, she is severely dyspneic and can answer questions only with one-word phrases. She is diaphoretic, with a heart rate of 132 beats/min, and blood pressure 98/70 mm Hg. She is extremely anxious.
1. Because this patient cannot breathe or talk easily, prioritize the immediate nursing assessments upon admission.
Assess respiratory status (lung sounds, O2 saturation), cardiac assessment (assess the HR and rhythm, BP, heart sounds, check pulses, edema)
2. Considering the process of congestive heart failure, explain the symptoms she is having: right sided heart failure results in inadequate right ventricle output and systemic venous congestion (peripheral edema). Fatigue and weakness will occur with right-sided failure. The low BP and high P are results from a decreased cardiac output, which results from the heart’s inability to pump effectively. Exertional dyspnea is expected with severe heart failure.
3. Based on assessment, identify the priority problems for this patient: respiratory status, high HR, and low BP (cardiac)
The physician orders a treatment plan for this patient: Start an IV, then give dobutamine 3 mg/kg/hr IV; furosemide (Lasix) 40 mg IV stat; digoxin 0.5 mg orally stat, then 0.125 every 6 hours for three doses, with ECG before doses 3 and 4; morphine 2 mg IV stat and then 2 mg IV every 1 to 2 hours PRN; oxygen 4 L/min per nasal cannula; schedule for an echocardiogram; no added salt diet; weigh daily and monitor input and output.
4. Explain the rationale for these medications and treatments: dobutamine increases the cardiac output without significantly increasing the heart rate which will help with perfusion. Furosemide is a diuretic which will mobilize excess fluid (edema) and lower the blood pressure. Digoxin
74-year-old woman is admitted to the hospital with heart failure. She had been growing progressively weaker and had ankle edema, dyspnea on exertion, and three-pillow orthopnea. On admission, she is severely dyspneic and can answer questions only with one-word phrases. She is diaphoretic, with a heart rate of 132 beats/min, and blood pressure 98/70 mm Hg. She is extremely anxious.
1. Because this patient cannot breathe or talk easily, prioritize the immediate nursing assessments upon admission.
Assess respiratory status (lung sounds, O2 saturation), cardiac assessment (assess the HR and rhythm, BP, heart sounds, check pulses, edema)
2. Considering the process of congestive heart failure, explain the symptoms she is having: right sided heart failure results in inadequate right ventricle output and systemic venous congestion (peripheral edema). Fatigue and weakness will occur with right-sided failure. The low BP and high P are results from a decreased cardiac output, which results from the heart’s inability to pump effectively. Exertional dyspnea is expected with severe heart failure.
3. Based on assessment, identify the priority problems for this patient: respiratory status, high HR, and low BP (cardiac)
The physician orders a treatment plan for this patient: Start an IV, then give dobutamine 3 mg/kg/hr IV; furosemide (Lasix) 40 mg IV stat; digoxin 0.5 mg orally stat, then 0.125 every 6 hours for three doses, with ECG before doses 3 and 4; morphine 2 mg IV stat and then 2 mg IV every 1 to 2 hours PRN; oxygen 4 L/min per nasal cannula; schedule for an echocardiogram; no added salt diet; weigh daily and monitor input and output.
4. Explain the rationale for these medications and treatments: dobutamine increases the cardiac output without significantly increasing the heart rate which will help with perfusion. Furosemide is a diuretic which will mobilize excess fluid (edema) and lower the blood pressure. Digoxin