CS Heart Failure.
Heart Failure
JoAnn Smith, 72 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Gas Exchange
2. Fluid and Electrolyte Balance
3. Clinical Judgment
, CS Heart Failure.
JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and systolic heart
failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. She presents to the
emergency department (ED) for shortness of breath (SOB) the past three days. Her shortness of breath has progressed
from SOB with activity to becoming SOB at rest. The last two nights she had to sleep in her recliner chair to rest
comfortably upright. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse.
She has noted increased swelling in her lower legs and has gained six pounds in the last three days. She is being
transferred from the ED to the cardiac step-down where you are the nurse assigned to care for her.
Personal/Social History:
JoAnn is a retired math teacher who is unable to maintain the level of activity she has been accustomed to because of the
progression of her heart failure the past two years. She has struggled with depression the past two years and has been
more withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
MI four years ago, MI is significant because it decreases heart function due to death
increase shortness of breath at rest; can only of myocardial muscle
speak in partial sentences, EF of 15% shows that the heart is having a hard time pumping blood out to
ischemic cardiomyopathy with EF of 15% rest of the body therefore starving it of oxygenated blood.
last two nights slept in recliner Weight gain and increased swelling signifies she is fluid overloaded and it
increased swelling in lower legs can be reason why she is having a hard time talking, breathing, being
gained 6 pounds in last 3 days active and why she has to sleep in a recliner the past 2 nights
RELEVANT Data from Social History: Clinical Significance:
Retired math teacher, recent widow, history Depression might affect her enthusiasm to recover, to stick to a therapy
of depression, decreasing activity level regimen
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• Diabetes mellitus type II 1. ASA 81 mg PO daily • Antiplatelets • Decrease chance
2. Carvedilol 3.25 mg • Beta blocker of clot formation
• Hypertension • Decrease blood
• Atrial fibrillation PO daily • ACE inhibitor pressure
3. Lisinopril 5 mg • Cholesterol • Decrease blood
• Hyperlipidemia medication
• Chronic renal PO daily pressure, helps with
• Vasodilator heart failure,
insufficiency (baseline 4. Ezetimide 10 mg
• Diuretic decrease chance of
creatinine 2.0) PO daily • Electrolyte
• Cerebral vascular 5. Hydralazine 25 mg replacement death from heart
accident (CVA) with no PO 4x daily • Anticoagulant attack
6. Torsemide 20 mg • Decrease
residual deficits • Antidiabetic cholesterol
• Heart failure (systolic) PO bid • Decrease blood
secondary to ischemic 7. KCL 20 meq PO daily pressure
8. Warfarin 5 mg PO daily • Decrease swelling,
cardiomyopathy decrease fluid
9. Glyburide 5 mg
• MI with stent x2 to LAD 4 PO daily overload
years ago • Increase serum
potassium
, CS Heart Failure.
• Thins the blood,
decrease chance
of
clot forming
• Treat type 2
diabetes, helps
control blood sugar
levels
Heart Failure
JoAnn Smith, 72 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Gas Exchange
2. Fluid and Electrolyte Balance
3. Clinical Judgment
, CS Heart Failure.
JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and systolic heart
failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. She presents to the
emergency department (ED) for shortness of breath (SOB) the past three days. Her shortness of breath has progressed
from SOB with activity to becoming SOB at rest. The last two nights she had to sleep in her recliner chair to rest
comfortably upright. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse.
She has noted increased swelling in her lower legs and has gained six pounds in the last three days. She is being
transferred from the ED to the cardiac step-down where you are the nurse assigned to care for her.
Personal/Social History:
JoAnn is a retired math teacher who is unable to maintain the level of activity she has been accustomed to because of the
progression of her heart failure the past two years. She has struggled with depression the past two years and has been
more withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
MI four years ago, MI is significant because it decreases heart function due to death
increase shortness of breath at rest; can only of myocardial muscle
speak in partial sentences, EF of 15% shows that the heart is having a hard time pumping blood out to
ischemic cardiomyopathy with EF of 15% rest of the body therefore starving it of oxygenated blood.
last two nights slept in recliner Weight gain and increased swelling signifies she is fluid overloaded and it
increased swelling in lower legs can be reason why she is having a hard time talking, breathing, being
gained 6 pounds in last 3 days active and why she has to sleep in a recliner the past 2 nights
RELEVANT Data from Social History: Clinical Significance:
Retired math teacher, recent widow, history Depression might affect her enthusiasm to recover, to stick to a therapy
of depression, decreasing activity level regimen
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• Diabetes mellitus type II 1. ASA 81 mg PO daily • Antiplatelets • Decrease chance
2. Carvedilol 3.25 mg • Beta blocker of clot formation
• Hypertension • Decrease blood
• Atrial fibrillation PO daily • ACE inhibitor pressure
3. Lisinopril 5 mg • Cholesterol • Decrease blood
• Hyperlipidemia medication
• Chronic renal PO daily pressure, helps with
• Vasodilator heart failure,
insufficiency (baseline 4. Ezetimide 10 mg
• Diuretic decrease chance of
creatinine 2.0) PO daily • Electrolyte
• Cerebral vascular 5. Hydralazine 25 mg replacement death from heart
accident (CVA) with no PO 4x daily • Anticoagulant attack
6. Torsemide 20 mg • Decrease
residual deficits • Antidiabetic cholesterol
• Heart failure (systolic) PO bid • Decrease blood
secondary to ischemic 7. KCL 20 meq PO daily pressure
8. Warfarin 5 mg PO daily • Decrease swelling,
cardiomyopathy decrease fluid
9. Glyburide 5 mg
• MI with stent x2 to LAD 4 PO daily overload
years ago • Increase serum
potassium
, CS Heart Failure.
• Thins the blood,
decrease chance
of
clot forming
• Treat type 2
diabetes, helps
control blood sugar
levels
