CHF Case Study

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia

2. The defect in Caleb’s heart allows blood to mix between the two ventricular chambers. Due to this defect would you expect the blood to move from left-to-right ventricle or right-to-left ventricle during systole? Explain your answer based on blood pressure and resistance in the heart and great vessels. It goes left to right during systole. The difference is normally, oxygen-poor (blue) blood returns to the right atrium from the body, travels to the right ventricle, and then is pumped into the lungs where it receives oxygen. Oxygen-rich (red) blood returns to the left atrium from the lungs, passes into the left ventricle, and then is pumped out to the body through the aorta. But when an infant has ventricular septal defect it still allows oxygen-rich (red) blood to pass from the left ventricle, through the opening in the septum, and then mix with oxygen-poor (blue) blood in the right ventricle. (ROCHESTER.EDU) but instead when systole occurs the blood gets mixed because of the septum therefore heart needs to pump harder to ensure that enough blood with oxygen reaches the body.

She converses appropriately. Blood pressure 92/60 supine. Blood pressure decreased to 72/50 standing. Pulse is 90 and regular. Weight 113 pounds. She has a normal appearance of her face and does not have a masked appearance of her face. She has good strength throughout her face. She has good strength of her extremities. She has only minimal cogwheel rigidity at the left wrist, but no cogwheel rigidity at the right wrist. She has no tremor of her hands. She moves her extremities freely and with normal speed. She is able to rise on her own from a sitting to a standing position, only minimal bradykinesia of standing. She walks fairly freely and there is a normal cadence of her gait. She did not have dyskinetic movements of her extremities. She is able to walk, including turning without losing her balance. She does not shuffle her feet when walking. She does not have en bloc turning. She has good posture stability

25) A 62 year-old woman comes to the ER with complaint of breathing difficulty and chest pain. Her blood pressure is 88/58. After the patient is placed on the cardiac monitor, the rhythm is as shown below. What is the best action that the nurse should take for the patient?

1. Which type of heart failure (left or right sided) is usually associated with dyspnea?

Similarly to how a problematic mitral valve can lead to left-sided heart failure, a faulty tricuspid valve may also do the same to the right side. Left-sided heart failure as a general rule of thumb inevitably leads to right-sided heart failure. Other causes of right ventricular failure include right ventricle infarction, massive pulmonary embolism, pulmonary hypertension, and chronic obstructive pulmonary disease or COPD for short.

by Nurse J. After five minutes, the diazepam had no effect so Dr.T ordered two milligrams of hydromorphone IVP given at 4:15 in the afternoon. The patient received another two milligrams of hydromorphone IVP and five milligrams diazepam IVP at 4:20 p.m. because Dr.T was not satisfied with the patient’s level of sedation. When the patient appeared to be sedated at 4:25 in the afternoon, the reduction of his left hip took place. At 4:35 p.m., Mr. B’s BP is 110/62 and his oxygen saturation is 92%. The “conscious sedation” policy was not followed. He did not have supplemental oxygen and his ECG and RR were not monitored. Then, Mr.B’s oxygen saturation dropped to 85%. The LPN adjusted the alarm and repeated the BP reading. Nurse J and the LPN were very busy taking care of the other patients during this time. At 4:43 p.m., Mr. B was not breathing, had no pulse, BP is 58/30 and oxygen saturation is 79%. The stat code was called.

examination was remarkable for crackles at her right lung base. The examination of her cardiac,

Heart failure is the inability of the heart to efficiently pump blood to the rest of the body. In left-sided heart failure, it is the faulty left ventricle that is not pumping blood effectively due to anatomical abnormalities or secondary factors that decrease its functionality. The purpose of this research paper is to inform the reader of statistical data on the disease as well as risk factors, usual signs and symptoms, diagnostic procedures, treatment and nursing implications.

It is my impression/diagnosis that Salma had vasovagal episode without reaching syncope, which we discussed during last ER visit and advised Salma to improve her fluid intake. Also Selma had a complete right bundle branch block on ECG, despite having normal cardiac anatomy on echocardiogram and no prior cardiac surgeries. Although this is more often seen in congenital heart disease and post cardiac surgical repair of certain congenital heart defects, it could be also seen in ischemia, myocarditis , cardiomyopathy and valvular heart disease . All of which ,Selma doesn't have signs of on her physical exam, ECG or echocardiogram. In very small group, it could be a normal variant which could explains this findings in Salma.

Assessment: the patient 's vital signs are 108/68, 125 beats per minute, respirations, even and non-labored at 14 breaths per minute, 92% on 2 liters of oxygen via nasal cannula, afebrile 98.5 F.

a. In this case, she was told that she only had six months to live which is not a long time. After considering treatments she

Radiographic features with heart failure will demonstrate changes in cardiac output and pulmonary venous pressure, evident in dilated pulmonary vessels, interstitial, pleural and alveolar fluid leakage, and increased systemic venous pressure with chronic disease (Cremers, Bradshaw & Herfkens, 2010). Based on the pathophysiological process present with Mrs. Smith, some of the following features might be noticeable: Redistributed pulmonary blood flow will be appreciated through an increased (normal 1-2 mm) artery-to-bronchus ratio at the hilar level in the upper and middle lobes; since gravity and positioning (supine versus erect and decubitus) will have an impact, comparison with serial or old films if existing will be helpful (Cremers et al.,

Cardiac: Regular rhythm without murmur, normal S1and S2. One plus edema to bilateral lower extremities. Capillary refills are presents and carotid bruits are absent.