Week Two Case Study Discussion Post

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Chamberlain College of Nursing *

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NR707

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Medicine

Date

Jan 9, 2024

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docx

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3

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A 72-year-old male presents to the primary care office with shortness of breath, leg swelling, and fatigue. He reports that he stopped engaging in his daily walk with friends three weeks ago because of shortness of breath that became worse with activity. He decided to come to the office today because he is now propping up on at least 3 pillows at night to sleep. He tells the NP that he sometimes sleeps better in his recliner chair. PMH includes hypertension, hyperlipidemia, and Type 2 diabetes. Physical Exam: BP 106/74 mmHg, Heart rate 110 beats per minute (bpm) HEENT: Unremarkable Lungs: Fine inspiratory crackles bilateral bases Cardiac: S1 and S2 regular, rate and rhythm; presence of 3rd heart sound; jugular venous distention. Bilateral pretibial and ankle 2+pitting edema noted. ECG: Sinus rhythm at 110 bpm Echocardiogram: decreased wall motion of the anterior wall of the heart and an ejection fraction of 25% Diagnosis: Heart failure, secondary to silent MI Discussion Questions Differentiate between systolic and diastolic heart failure. o When it comes to the cardiac system the heart pumps in cycles of relaxing and contracting. Ejection fraction is the percentage of blood the left ventricle pumps out with each beat. When the heart contracts this is the systolic portion and blood is sent out of the ventricles. Therefore, in Systolic Heart Failure , the left ventricle is not able to contract how it should. This makes the heart unable to pump properly and therefore it cannot push enough blood to circulate. This is also known as heart failure with a reduced ejection. Some common causes of Systolic Heart Failure Include but are not limited to Myocardial Infarction, Cardiomyopathy, and coronary artery disease. A hallmark symptom of Systolic Heart Failure is dyspnea or shortness of breath. Other symptoms may include chest pain, dizziness, frequent cough, as well as nausea. As Systolic Heart Failure progresses it will lead to edema or swelling in legs, ankles, and feet. In Systolic Heart Failure the ejection fraction is usually less than 50% ( Systolic heart failure, 2022). When the heart is in the relaxation cycle, the chambers of the heart begin to fill with blood. This is the diastolic phase. In Diastolic Heart Failure , the left ventricle is not able to relax how it should because the muscle has become stiff. This means that the heart is unable to fill properly during the resting period. This is known as heart failure with preserved ejection. The most common cause of
Diastolic Heart Failure is chronic hypertension. Some of the symptoms of Diastolic Heart Failure are dyspnea, pulmonary congestion, and hypertension (American Heart Association, 2023). State whether the patient has systolic or diastolic heart failure. o Due to the patients’ subjective symptoms of shortness of breath, leg swelling, and fatigue as well as the objective symptoms of tachycardia, crackles in the lungs, 2+ pitting edema and a decreased ejection fraction of 25%. It is also reported that the diagnosis of heart failure is secondary to a silent myocardial infarction. The heart failure came after a history of hypertension, hyperlipidemia, and Type 2 Diabetes as well. The patient is believed to have Systolic Heart Failure. Explain the pathophysiology associated with each of the following symptoms: dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea. o Dyspnea on Exertion: This symptom occurs in patients with Systolic Heart Failure because of the pulmonary congestion that occurs after the cardiac output decreases and the pulmonary pressure begins to rise (American Heart Association, 2023). This is why patients with Systolic Heart Failure often sleep propped up on pillows. o Pitting Edema: This symptom is identified by pressing on the patients’ skin where swelling is noted, and the indention stays in the skin. During Systolic Heart Failure the heart is unable to pump efficiently and blood as well as fluids then back up into the tissues ( Systolic heart failure, 2022). o Jugular Vein Distention (JVD): This symptom occurs when blood begins to accumulate in the lungs. This in turn causes the right ventricle to work harder and it eventually is not able to pump properly. As the blood starts to accumulate the veins begin to bulge (Shono, 2019). o Orthopnea: This symptom is a shortness of breath that occurs when you lay flat but is relieved by sitting or standing up. This occurs when the body is unable to pump the extra blood and fluids out of the body that has accumulated. When it is unable to filter the extra fluid out it causes extra pressure in the veins and capillaries in your lungs making it harder for the patient to breathe ( Systolic heart failure, 2022). Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%. o The presence of a 3 rd heart sound is significant because this is a symptom of volume overload or heart failure. This can be caused by a lowered ejection
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