Heart Failure Case Study Essay

Your client, Mr. mordant, is a 72-year-old man who called his Tele concord aviation from home and, based on the symptoms he descrilayer, was advised to go directly to the mite Department at his local hospital. His admitting diagnosis is exacerbation of shopping center harm (HF). His Ht is 59, Wt. 235 lbs. He states that his usual fish is about 220. Upon admission, his symptoms are extreme suddenness of breath un able-bodied to tole rove imposition flat heavy, aching feeling in his chest respirations labored 32/min. radiate wink 108 and regular BP 150/78 color dusky and O2 Sat is 82% on room air pure diaphoresis peripheral edema is 3+ pitting, ankle to knee bilaterally and sacral edema is alike present. Bilateral BS present with coarse crackles in both lower lobes. He appears frightened and noisome he states, This is the worst it has ever been recreate dont leave me alone. ago Medical/Social History coronary artery Disease (CAD), hypertension, cor pulmonale, emphysem a-moderate wooden leg. He smoked 2 packs per day for 35 years, and leave 5 years ago. Hospitalized 3 time previously for HF the some new-fangled hospitalization was 6 months ago. He is a retired insurance salesperson married and lives with his married woman in a condominium. Sedentary modus vivendi plays golf occasionally. He skipped his diuretics over the weekend because he was golfing.1. Which stage of the NYHA classification form and the ACC/AHA staging system would Mr. Bs symptoms best fit deep down? wherefore?I think his NYHA classification would be physique II. He has Coronary Artery disorder and ordinary exercise causes exhaust for him Mr. Bs ACC/AHA stage is detail D. He has been hospitalized 3 times previously for HF.2. controvert the differences between right and left over(p) nub failure, consider the  pathophysiology, physiological progression, and signs and symptoms. left over(p) Sided-The most common-Results from left ventricular dysfunction. This pr change surfacets public forward railway line flow causing blood to back up into the left atrium and pulmonary veins. Increased pulmonary contract causes fluid leakage from pulmonary capillary bed into the interstitial and then the alveoli -Manifests as pulmonary over-crowding and edema discipline Sided-occurs when right ventricle fails to contract 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(prenominal) as right ventricular infarction or pulmonary embolism -Core Pulmonale hindquarters 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. s bottomdalouss orders overwhelm a bedside chest roentgen ray, ECG, echocardiogram, and the pursual labs Troponin I, CK-MB, CBC with differential, BNP, digoxin level, Electrolytes, Mg++, ABGs, BUN and creatinine. What is the rationale for performing each of these diagnostics tests? How will the findings/ study obtained from the tests be useful in managing Mr. vitriolics care?Bedside chest x-rayECGTroponin I present in MIsCK-MBCBCBNP High in patients with HFDigoxinElectrolytesMgABGBUNCreatinineMr. Black is stabilized and transferred to the Cardiac Telemetry unit with the following ordersOxygen at 2-4 liters per nasal cannula to corroborate O2 Sat > 90%Complete bed quiet with HOB elevated 60-90 degrees, legs leechlikeSaline Lock IVFurosemide (Lasix) 80 mg I.V. push StatI&OFurosemide (Lasix) 80 mg I.V. push every 8 hr.Daily charge Al exclusivelyerol inhaler 2 puffs doubly per day urge oximetry continuousK-Dur 10 mg. p.o. passing(a)Foley catheterASA 81 mg p.o. dailyTelemetryMetoprolol 100 mg p.o. twice dailyDiet 2 Gm Na Lisinopril 10 mg p.o. daily melted restriction of chiliad mL/dayHCTZ 50 mg p.o. dailyCode status Full codeDigoxin 0.25 mg p.o. daily Hold for HR < 60 bpmLovenox 60mg SQ every 12 hrsDucosate sodium 100 mg p.o. daily4. dispute the rationale for each of the orders abovePatients with HF typically see oxygenation problemsFurosemide is a loop diureticDaily Weight- pissing retentionPulse ox- admonisher O2Foley Catheter monitoring imposture output and on bed restK DurASAMetoprolol beta blocking agent that treats high BPLisinopril ACE inhibitor for HTNLovenox Prevents and treats clotsFluid Restriction Excess fluid strains the joinDigoxin Treats rhythmic problemsDucosate Stool Softener5. disclose 3 priority nursing diagnoses to include in the nursing care throw for Mr. Black.Excess fluid volume decrease cardiac outputImpaired be adrift exchange6. What changes/assessment findings would alert the keep back that Mr. Blacks condition is worsen?Fatigue 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 handling 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 love child and able to sleep comfortably with 2 pillows. Discharge plans are finalized.7. Which state of the NYHA mixed bag system and the ACC/AHA staging systemWould Mr. Blacks symptoms now fit?NYHA- Class IIACCF/AHA- leg C8. bring 2 flush topics (your choice) to focus on. Discuss what should be included in the discharge instructing plan for Mr. B. (and his wife) for each topic. use and rest act upon training can improve symptoms of HF, however Mr. B inevitably to understand that he will postulate lots of rest during and after exercise and that he shouldnt overexert himself. con Mr . Bs wife to monitor his exercise and encourage him to take breaks when essentialDrug therapy Teach Mr. B and his wife the expected action of all his practice of medicine and how to recognize drug toxicity. Also teach him and his wife how to take a pulse rate and what range the pulse rate should be in. Teach them the symptoms of hypokalemia and hyperkalemia if diuretics are order. ego BP monitoring may also be appropriate in Mr. Bs situation. partiality FailureNew York Heart Association ClassificationAmerican College of Cardiology/American Heart Association Guidelines Treatment RecommendationsStage A. People at high run a risk of developing nucleus failure (HF) but without geomorphologic heart disease or symptoms of HF-Treat hypertension, lipid disorders, diabetes.-Encourage patient to catch smoking and to exercise regularly.-Discourage use of alcohol, outlaw(a) drugs.-ACE inhibitor if indicatedClass I. Patients with cardiac disease without limitations of strong-arm activity. characterless animal(prenominal) activity doesnt cause undue fatigue, palpitations, dyspnea, or anginose pain. Stage B. People who have structural heart disease but no symptoms of HF.-All stage A therapies-ACE inhibitor unless contraindicated-Beta-blocker unless contraindicatedClass II. Patients with cardiac disease who have slight limitations of carnal 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. slight than ordinary physical activity causes fatigue, palpitations, dyspnea, or anginal pain.Stage C. People who have structural heart disease with online or prior symptoms of heart failure. -All stage A & B therapies-Sodium-restricted nourishment-Diuretics-Digoxin-Avoid or withdraw antiarrhythmic agents, most calcium channel blockers, and nonsteroidal anti- unhealthy drugs.-Cons ider aldosterone antagonists, angiotensin receptor blockers, hydralazine, and nitrates. Class IV. Patients with cardiac disease who cant pass on out any physical activity without discomfort. Symptoms of cardiac insufficiency 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 take to heart 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 and detectable4+ pitting morose and deep (1 or 2.54 cm.)