LATEST HESI Case study Heart Failure with Atrial Fibrillation Jonathan Stevens

Meet the Client: Jonathan StevensSixty-three-year-old Jonathan Stevens visits the healthcare clinic complaining of increasing fatigue and difficulty breathing. Physical assessment findings include a rapid, irregular heart rate of 138 beats/min, BP of 140/86 mmHg, and a respiratory rate of 28 breaths/min. His breath sounds are clear with fine crackles in the bases bilaterally. He has positive jugular vein distention (JDV) bilaterally and 1+ pitting edema of his ankles bilaterally. His initial medical diagnosis is heart failure (HF). Jonathan is immediately admitted to the acute care facility for further evaluation and treatment. - answer Risk Factors Heart failure occurs most commonly in clients over the age of 60, and occurs more commonly in males than females. In addition to these two risk factors, which question will provide the nurse the best data about any additional risk factors for heart failure? "Do you have any chronic lung disorders?" "Have you ever had a heart attack?" "Do you have varicose veins?" "Have you ever had low blood pressure?" - answer "Have you ever had a heart attack?" Myocardial infarction, coronary artery disease, and ischemic heart disease are among the most common underlying causes of heart failure. In fact, the most common cause of heart failure is myocardial infarction. The nurse should also ask Jonathan if he has hypertension, another primary underlying condition causing heart failure. Clinical Manifestations - answer Which assessment finding would indicate to the nurse that Jonathan is experiencing right-sided heart failure? Dyspnea. Tachycardia. Edema. Fatigue. - answer Edema. Right-sided heart failure results in peripheral congestion due to the inability of the right ventricle to effectively pump blood out of the heart to the lungs, causing edema, JVD, an enlarged liver, abdominal ascites, and weight gain. Cardiac Dysrhythmias Left-sided heart failure results in pulmonary fluid overload, and right-sided heart failure results in peripheral fluid overload. Left-sided heart failure usually occurs first, and can trigger right-sided heart failure. Upon admission to the Cardiac Nursing Unit, Jonathan's dyspnea continues. He reports fatigue, but denies chest pain. The nurse places Jonathan on oxygen via a nasal cannula at 3 L/min and a cardiac telemetry monitor. The ECG recording shows no discernible P waves, and a rapid, irregular ventricular response (QRS complexes). This corresponds with Jonathan's pulse rate, which is 136 and irregular. - answer Which cardiac dysrhythmia is Jonathan most likely experiencing? Which cardiac dysrhythmia is Jonathan most likely experiencing? Sinus tachycardia. Atrial fibrillation. Ventricular fibrillation. Asystole. - answer sinus tachycardia. Sinus tachycardia is distinguished by a heart rate greater than 100 beats per minute, a regular rhythm present, and P waves. Atrial fibrillation. Atrial fibrillation commonly occurs in heart failure. Multiple areas in the atria initiate rapid, irregular electrical stimuli, which results in the inability to see clear P waves on the ECG recording. Some, but not all, of these electrical impulses travel through the AV node, causing an irregular ventricular response. This appears as irregular QRS complexes on the ECG recording and manifests as an irregular pulse rhythm when assessing the client. Ventricular fibrillation. Ventricular fibrillation is distinguished by totally chaotic electrical activity on the ECG recording, with no discernible P waves or QRS complexes (ventricular response). In addition, the client would not be arousable and would lack a pulse. This fatal dysrhythmia requires immediate defibrillation and CPR. Asystole. Asystole is distinguished by a flat line (no electrical activity of any kind) on the ECG recording. In addition, the client would not be arousable and would lack a pulse. This fatal dysrhythmia requires immediate CPR. Based on Jonathan's cardiac dysrhythmia, which action should the nurse implement first? Based on Jonathan's cardiac dysrhythmia, which action should the nurse implement first? Administer a prescribed stat dose of digoxin (Lanoxin). Notify the health care provider of the dysrhythmia. Transfer Jonathan to the Medical Intensive Care Unit. Prepare for synchronized cardioversion. - answer Administer a prescribed stat dose of digoxin (Lanoxin). If a dose of digoxin has already been prescribed, it should be administered before taking further action. Digoxin slows the heart rate and increases the force of the heart's contraction, which is very useful in the treatment of Jonathan's type of cardiac dysrhythmia. Diagnostic Studies Jonathan is scheduled for a chest x-ray and 12 lead electrocardiograph (ECG). Additional diagnostic studies that may be performed include echocardiography and pulmonary artery catheterization. - answer Which of these diagnostic tests is used to measure the pressure within the right atrium? Chest x-ray. Electrocardiograph. Echocardiography. Pulmonary artery catheterization. - answer Pulmonary artery catheterization. Pulmonary artery catheters are used in the management of acutely ill clients in the critical care setting. Catheterization allows measurement of the pressures within the right atrium and pulmonary artery, which then guides treatment. Case Study Details