Heart Failure Case Study Essay

Your client, Mr. dingy, is a 72-year-old man who called his Tele go down on Line from theme and, based on the symptoms he descri contend, was hash out to go directly to the Emergency section at his local hospital. His admitting diagnosis is irritation of tit failure (HF). His Ht is 59, Wt. 235 lbs. He states that his usual cargo is closely 220. Upon admission, his symptoms be extreme shortness of steer unable to tolerate lying even heavy, aching feeling in his titty respirations labored 32/min. radial trice 108 and regular BP 150/78 mask dusky and O2 sit down is 82% on room air slight perspiration peripheral dropsy is 3+ pitting, mortise-and-tenon joint to knee bilaterally and sacral edema is excessively break. Bilateral BS beat with coarse crackles in both debase lobes. He appears f skilfulened and anxious he states, This is the worst it has ever been please tire outt leave me alone.Past health check/Social History Coronary arteria Disease (CAD), hypertens ion, cor pulmonale, emphysema-moderate stage. He smoked 2 packs per day for 35 years, and quit 5 years ago. Hospitalized 3 times antecedently for HF the most recent hospital care was 6 months ago. He is a retired indemnification salesperson married and lives with his wife in a condominium. Sedentary life-style plays golf occasionally. He skipped his diuretics over the weekend because he was golfing.1. Which stage of the NYHA classification system and the ACC/AHA represent system would Mr. Bs symptoms surpass fit within? Why?I think his NYHA classification would be clear II. He has Coronary Artery ailment and ordinary use causes fatigue for him Mr. Bs ACC/AHA stage is dress D. He has been hospitalized 3 times previously for HF.2.Discuss the differences surrounded by right and left spunk failure, pick up the pathophysiology, physiological progression, and signs and symptoms.Left Sided-The most coarse-Results from left ventricular dysfunction. This prevents normal antece dent livestock flow causing blood to back up into the left atrium and pulmonic veins. Increased pneumonic pressure causes facile leakage from pulmonary capillary bed into the interstitial and then the alveoli -Manifests as pulmonary over-crowding and edemaRight Sided-occurs when right ventricle fails to contract effectively. -Causes a replacement of blood into the right atrium and venous circulation. -Venous congestion in the systemic circulation outcomes in vena jugularis venous distention, hepatomegaly, splenomegaly, vascular congestion of the GI tract, and peripheral edema-May also result from an acuate condition such as right ventricular infarction or pulmonary embolism -Core Pulmonale can also cause right sided HF-Its patriarchal cause is Left sided HF. Left sided HF results in pulmonary congestion and increase pressure in the blood vessels of the lungs. eventually chronic pulmonary hypertension results in right sided hypertrophy and HF3. Mr. denses orders include a b edside chest x-ray, cardiogram, echocardiogram, and the following labs Troponin I, CK-MB, complete blood count with differential, BNP, digoxin level, Electrolytes, Mg++, ABGs, BUN and creatinine. What is the rationale for performing to from each one one of these diagnostics tests? How will the findings/information obtained from the tests be useful in managing Mr. Blacks care?Bedside chest x-rayECGTroponin I present in MIsCK-MBCBCBNP High in patients with HFDigoxinElectrolytesMgABGBUNCreatinineMr. Black is stabilize and transferred to the Cardiac Telemetry unit with the following orderstype O at 2-4 liters per nasal cannula to keep O2 Sat 90%Complete bed residue with HOB elevated 60-90 degrees, legs dependent saline Lock IVFurosemide (Lasix) 80 mg I.V. touch on StatI&OFurosemide (Lasix) 80 mg I.V. pressure all 8 hr.Daily weight Albuterol Inhaler 2 puffs doubly per day shudder oximetry continuousK-Dur 10 mg. p.o. free-and-easyFoley catheterASA 81 mg p.o. dailyTelemetrymeto prolol degree Celsius mg p.o. twice daily nourishment 2 Gm Na lisinopril 10 mg p.o. daily precarious busy a breatherriction of 1000 mL/dayHCTZ 50 mg p.o. dailyCode posture Full codeDigoxin 0.25 mg p.o. daily grip for HR 60 bpmLovenox 60mg SQ every 12 hrsDucosate sodium 100 mg p.o. daily4. Discuss the rationale for each of the orders abovePatients with HF typically suffer oxygenation problemsFurosemide is a loop diureticDaily Weight- water retentionPulse ox- monitor O2Foley Catheter monitor payoff and on bed restK DurASAMetoprolol beta blocker that treats high BPlisinopril ACE inhibitor for HTNLovenox Prevents and treats clotsFluid Restriction superabundance melted strains the feelDigoxin Treats chantlike problemsDucosate Stool Softener5. Identify 3 antecedence nurse diagnoses to include in the nursing care formulate for Mr. Black.Excess fluid volumeDecreased cardiac outputImpaired gas exchange6. What changes/ judicial decision findings would alert the nurse that Mr. B lacks condition is worsening?Fatigue and dyspnea continue to worsen, weight continues to increase, edema and chest pain worsens, pleural effusion and dysrhythmias fix to develop, hepatomegaly, and renal failure begins to occurMr. Black responds well to the treatment plan and his acute symptoms resolve within 3 days. His weight returns to 220 lbs. and he is able to perform his ADLs with minimal SOB and able to slumber comfortably with 2 pillows. Discharge plans are finalized.7. Which state of the NYHA categorisation system and the ACC/AHA staging systemWould Mr. Blacks symptoms instanter fit?NYHA- category IIACCF/AHA- act C8. Select 2 dismission topics (your choice) to focus on. Discuss what should be include in the discharge teaching plan for Mr. B. (and his wife) for each topic.Activity and rest elaborate training can improve symptoms of HF, that Mr. B needs to understand that he will need lots of rest during and after lick and that he shouldnt overexert himself. inform Mr. Bs wife to monitor his exercise and gain him to take breaks when neededDrug therapy check Mr. B and his wife the expected work on of all his medication and how to recognize dose toxicity. Also teach him and his wife how to take a pulse rate and what race the pulse rate should be in. Teach them the symptoms of hypokalemia and hyperkalemia if diuretics are order. Self BP monitoring may also be appropriate in Mr. Bs situation.Heart troubleNew York Heart association frameificationAmerican College of Cardiology/American Heart Association Guidelines Treatment RecommendationsStage A. tribe at high risk of developing tone failure (HF) but without structural heart affection or symptoms of HF-Treat hypertension, lipid disorders, diabetes.-Encourage patient to stop smoking and to exercise regularly.-Discourage use of alcohol, illicit drugs.-ACE inhibitor if indicatedClass I. Patients with cardiac disease without limitations of somatogenetic activity. Ordinary physiologic act ivity doesnt cause excessive fatigue, palpitations, dyspnea, or anginal pain. Stage B. People who tolerate structural heart disease but no symptoms of HF.-All stage A therapies-ACE inhibitor unless contraindicated-Beta-blocker unless contraindicatedClass II. Patients with cardiac disease who have slight limitations of fleshly activity. Theyre soothing at rest. Ordinary fleshly activity results in fatigue, palpitations, dyspnea, or anginal pain.Class III. Patients with cardiac disease who have mark limitation of physical activity. Theyre at ease at rest. Less than ordinary physical activity causes fatigue, palpitations, dyspnea, or anginal pain.Stage C. People who have structural heart disease with current or precedentsymptoms of heart failure. -All stage A & B therapies-Sodium-restricted diet-Diuretics-Digoxin-Avoid or withdraw antiarrhythmic drug agents, most calcium channel blockers, and nonsteroid anti- inflammatory drugs.-Consider aldosterone antagonists, angiotensin re ceptor blockers, hydralazine, and nitrates. Class IV. Patients with cardiac disease who cant carry out any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. Any physical activity increases discomfort. Stage D. People with obdurate heart failure that requires specialized interventions.-All therapies for A, B, and C-Mechanical advocate device, such as biventricular artificial pacemaker or left ventricular assist device-Continuous inotropic therapy-Hospice careCaboral, M. & Mitchell J. (2003). New guidelines for heart failure focus on prevention. The Nurse Practitioner, 28, 22.Evaluation of EdemaFour-point scale 1+ to 4+1+ pitting further detectable4+ pitting grim and deep (1 or 2.54 cm.)