Heart Failure Clinical Reasoning Case Study _Acute Coronary Syndrome Case Study 2

Circulation (Perfusion) Heart Failure Clinical Reasoning Case Study Case Study 2 Overview This case study is a common presentation seen by the nurse in clinical practice: Acute Coronary Syndrome Concepts Gas Exchange Infection Acid-Base Balance Thermoregulation Clinical Judgment Pain Acute Coronary Syndrome I. Data Collection History of Present Problem: Carlos Boccerini is a 68-year-old male who has a 5-year history of systolic heart failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. He presents to the emergency department (ED) for shortness of breath (SOB) the past 3 days. His shortness of breath has progressed from SOB with activity to becoming SOB at rest. The last two nights he had to sleep in his recliner chair to rest comfortably with his head partially elevated. He is able to speak only a partial sentence and then has to take a breath when talking to the nurse. He has noted increased swelling in his lower legs and has gained 6 pounds in the last 3 days. He is being transferred from the ED to the cardiac step-down where you are assigned to care for him. Personal/Social History: Carlos has been married for 45 years and has 4 children. He is a retired baker who had to retire early due to medical problems secondary to his progressive heart failure. The family celebrated two birthdays this week and Jim made it to both parties. His wife does most of the cooking at home and follows his need for sodium restrictions, but during the celebrations, Carlos made his own dietary choices.