(Answered) NUR303 Heart Failure Case Study: JoAnn Smith, 72 years old Woman.

(Answered) NUR303 Heart Failure Case Study: JoAnn Smith, 72 years old Woman. 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 4. Patient Education 5. Communication 6. Collaboration © 2016 Keith Rischer/www.KeithRN.com UNFOLDING Reasoning Case Study: STUDENT Heart Failure History of Present Problem: 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 progressefrom 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 nuShe 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 ofprogression of her heart failure the past two years. She has struggled with depression the past two years and has beemore withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction.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: -Hx of MI 4 yrs ago -ER 15% -SOB @ rest -speak in partial sentences -Increased swelling in lower legs -weight gain -sx supporting Left sided heart failure -Decreased O2 in blood RELEVANT Data from Social History: Clinical Significance: -Unable to maintain normal activity levels -depression, lost husband 3 mos ago -Anxiety can increase body’s demand for SOB -Independent living can be a safety concern -Depression What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition?Put number next to PMH that connects to Medication) PMH: Home Meds: Pharm. Classification:Expected Outcome: Diabetes Mellitus type II Hypertenson Artial afibrillation Hyperlipidemaia Chronic renal insufficency (baseline Creatinine 2.0) Cerebral vascular accident (CVA) with no residual deficits Heart Failure (systolic) secondary to ischemic cardiomyopathy MI with stent x2 to 1. ASA 81 mg PO daily 2. Carvedilol 3.25 mg PO daily 3. Lisinopril 5 mg PO daily 4. Ezetimide 10 mg PO daily 5. Hydralazine 25 mg PO 4x daily 6. Torsemide 20 mg PO bid 7. KCL 20 meq PO daily 8. Warfarin 5 mg PO daily 9. Glyburide 5 mg PO daily 1. Antiplatelet 2. Beta blocker 3. Ace Inhibitor 4. Antilipidemic med 5. Vasodilator 6. Loop diuretic 7. Electrolyte supplement 8. Anticoagulant 9. Sulfonylurea 1. Prevent clots 2. Decrease bp, regulate HR 3. Decrease bp 4. Lower cholesterol levels 5. Decrease bp 6. Decrease fluid overload, edema 7. Replace potassium 8. Prevent clots LAD 4 years ago 9. Reduce blood sugar © 2016 Keith Rischer/www.KeithRN.com What medications treat which conditions? One disease process often influences the development of other illnesses. Based on your knowlepathophysiology, (if applicable), which disease likely developed FIRST that created a “domino eWrite what PMH problem likely started FIRST -DM, HTN Write what PMH problems(s) FOLLOWED as domino(s) -AFIB, hyperlipidemia,HTN, MI Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment (5th VS): T: 98.6 F/37.0 C (oral) Provoking/Palliative: P: 92 (irregular) Quality: Denies Pain R: 26 (regular) Region/Radiation: BP: 162/54 MAP: 90 Severity: O2 sat: 90% (6 liters n/c) Timing: What VS data is RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance: P: 92 irregular R: 26 BP: 162/54 O2: 90% Arrhythmia, maybe caused by anxiety as well Tachypnea, resp distress High BP Increase cardiac output Current Assessment: GENERAL APPEARANCE: Appears anxious, restless RESP: Breath sounds have coarse crackles scattered throughout both lung fields ant/post, labored respiratory effort, patient sitting upright CARDIAC: Rhythm: atrial fibrillation, pale, cool to the touch, pulses palpable throughout, 3+ pitting edema lower extremities from knees down bilaterally, S3 gallop, irregular, no jugular venous distention (JVD) noted NEURO: Alert and oriented to person, place, time, and situation (x4) GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact, skin turgor elastic, no tenting present.