Heart Failure Clinical Reasoning Case Study
Mr. Kelly
Chief Complaint/History of Present Illness:
It has now been 3 years since Mr. Kelly has been discharged from the hospital for
CAD & MI. He is now 56 years old. He has not had any recurrent CP, but has had to
sleep with 3 pillows to keep from becoming SOB at night the last 2 weeks. He has
had difficulty getting his shoes on the last month because of increased swelling
around his ankles. He forgets to take his medications every day but does at least 4-
5 times a week. He weighs himself once a week and today his weight has increased
from 255 lbs. to 264 lbs. the last 7 days. He makes an appt. through his clinic when
he becomes concerned that he is now becoming SOB at rest and is more fatigued.
The clinic physician recognizes that he will need acute inpatient care and
coordinates a direct admission to the hospital by EMS.
Past Medical History:
HTN - HCTZ, lisinopril
Hyperlipidemia – simvastatin and fish oil
CAD -
MI
DM-type II - glyburide
Home Medications:
Simvastatin 20 mg po daily
Glyburide 10 mg po daily
HCTZ 50 mg po daily
Lisinopril 20 mg po daily
ASA 81 mg po daily
Fish oil 1000 mg po 2 tabs daily
Social/personal history
Lives alone in own home. He is divorced with three grown children. He has had to
cut back working to only 4 hours a day as a mechanic because of fatigue and
weakness since the first of the year.
I. Pre-Clinical Critical Thinking: Identifying Relationships
1. What is the relationship of his medical history and current medications?
(Which medication treats which disease? Draw a line to
connect)
Past Medical History: Home Medications:
HTN Simvastatin 20 mg po daily
Hyperlipidemia Glyburide 10 mg po daily
CAD HCTZ 50 mg po daily
MI Lisinopril 20 mg po daily
DM-type II ASA 81 mg po daily
Fish oil 1000 mg po 2 tabs daily
, 2.One disease process often influences the development of other illnesses. Based on
your knowledge of pathophysiology, in Mr. Kelly which disease likely developed first
that initiated a “domino effect” in his life?
Past Medical History: What Came First:
HTN, Hyperlipidemia
Hyperlipidemia
CAD What then followed:
MI DM, HTN, CAD, MI, Heart Failure
DM-type II
Heart failure (new dx)
3. What is the relationship of his past medical history and current chief complaint?
Are there any pre-existing conditions that directly influenced his current problem?
Explain your rationale if present
Past Medical History: Chief Complaint:
HTN, Has had to sleep with 3 pillows to keep from becoming SOB at night the last 2
Hyperlipidemia months. Heart failure
CAD He has had difficulty getting his shoes on the last month because of
MI increased swelling around his ankles. Heart failure (right)
DM-type II His weight has increased from 255 lbs. to 264 lbs. the last 7 days. Heart
Heart failure (new dx) failure (left)
Becomes concerned that he cannot get out of his chair without becoming
more SOB and is more fatigued heart failure
Mr. Kelly arrives to your telemetry unit
You are the telemetry floor nurse and you have just received him as a direct admit.
You review his history through the electronic medical record. The paramedics
relate the above story of why he is being admitted.
Current Status:
Admission VS:
o T:98.4
o P:126-regular
o R:28/labored
o BP:184/108
o O2 sats:90% 2l per n/c
Admission Nursing Assessment:
o CV: pale, cool to the touch. Pulses 2+ throughout. 2-3+ pitting
edema lower extremities
Mr. Kelly
Chief Complaint/History of Present Illness:
It has now been 3 years since Mr. Kelly has been discharged from the hospital for
CAD & MI. He is now 56 years old. He has not had any recurrent CP, but has had to
sleep with 3 pillows to keep from becoming SOB at night the last 2 weeks. He has
had difficulty getting his shoes on the last month because of increased swelling
around his ankles. He forgets to take his medications every day but does at least 4-
5 times a week. He weighs himself once a week and today his weight has increased
from 255 lbs. to 264 lbs. the last 7 days. He makes an appt. through his clinic when
he becomes concerned that he is now becoming SOB at rest and is more fatigued.
The clinic physician recognizes that he will need acute inpatient care and
coordinates a direct admission to the hospital by EMS.
Past Medical History:
HTN - HCTZ, lisinopril
Hyperlipidemia – simvastatin and fish oil
CAD -
MI
DM-type II - glyburide
Home Medications:
Simvastatin 20 mg po daily
Glyburide 10 mg po daily
HCTZ 50 mg po daily
Lisinopril 20 mg po daily
ASA 81 mg po daily
Fish oil 1000 mg po 2 tabs daily
Social/personal history
Lives alone in own home. He is divorced with three grown children. He has had to
cut back working to only 4 hours a day as a mechanic because of fatigue and
weakness since the first of the year.
I. Pre-Clinical Critical Thinking: Identifying Relationships
1. What is the relationship of his medical history and current medications?
(Which medication treats which disease? Draw a line to
connect)
Past Medical History: Home Medications:
HTN Simvastatin 20 mg po daily
Hyperlipidemia Glyburide 10 mg po daily
CAD HCTZ 50 mg po daily
MI Lisinopril 20 mg po daily
DM-type II ASA 81 mg po daily
Fish oil 1000 mg po 2 tabs daily
, 2.One disease process often influences the development of other illnesses. Based on
your knowledge of pathophysiology, in Mr. Kelly which disease likely developed first
that initiated a “domino effect” in his life?
Past Medical History: What Came First:
HTN, Hyperlipidemia
Hyperlipidemia
CAD What then followed:
MI DM, HTN, CAD, MI, Heart Failure
DM-type II
Heart failure (new dx)
3. What is the relationship of his past medical history and current chief complaint?
Are there any pre-existing conditions that directly influenced his current problem?
Explain your rationale if present
Past Medical History: Chief Complaint:
HTN, Has had to sleep with 3 pillows to keep from becoming SOB at night the last 2
Hyperlipidemia months. Heart failure
CAD He has had difficulty getting his shoes on the last month because of
MI increased swelling around his ankles. Heart failure (right)
DM-type II His weight has increased from 255 lbs. to 264 lbs. the last 7 days. Heart
Heart failure (new dx) failure (left)
Becomes concerned that he cannot get out of his chair without becoming
more SOB and is more fatigued heart failure
Mr. Kelly arrives to your telemetry unit
You are the telemetry floor nurse and you have just received him as a direct admit.
You review his history through the electronic medical record. The paramedics
relate the above story of why he is being admitted.
Current Status:
Admission VS:
o T:98.4
o P:126-regular
o R:28/labored
o BP:184/108
o O2 sats:90% 2l per n/c
Admission Nursing Assessment:
o CV: pale, cool to the touch. Pulses 2+ throughout. 2-3+ pitting
edema lower extremities
