CHF Case Study

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Case Study Pg 204: Essentials of Critical Care Nursing
Mrs. K., A 68 year-old white woman, has been admitted to the critical care unit with shortness of breath at rest. Vital signs are BP, 218/100 mm Hg; HR, 110 beats/min; and RR, 3 breath/min. She has run out of her antihypertensive medication for the fourth time this year and only came to the hospital because of her breathing difficulties.
On examination, Mrs. K. is pale and clammy sitting upright in a chair. She has bibasilar crackles to her scapulae, and her heart rhythm is irregularly irregular. She has pitting edema bilaterally to her thighs, jugular venous pulsation to the earlobe, and bilateral infiltrates. An ECG shows a left ventricular ejection fraction of 78% with …show more content…

Even with the limits of Amiodarone, it is often used as the first line drug of choice for A-Fib and those that are hemodynamically unstable. Amiodarone is a vasodilator and can increase cardiac output. However, it will not significantly change the ejection fraction which is good since Mrs. K.’s is 78% (normal approximately 55-75%)
c. I did not see any treatments for her A-Fib. There is no mention of thombolytics or anti-coagulants. This should also be considered for treatment.
2. Based on her presentation, physical assessment and hemodynamic number, was Mrs. K. experiencing left- or right-sided failure, or both?
a. Both. Based on what is presented. She has JVD – an indication of right sided failure because the heart is unable to pump the massive amount of fluid coming from the body to the right side of the heart. There is too much fluid for the right ventricle to pump into the pulmonary arteries. And because of the A-fib, it is not being “pumped” efficiently.
b. She is experiencing left sided failure as shown by the increased PAP and the bibasilar crackles heard on auscultation. The fluid can’t get into the left side of the heart and is backing up into the lungs. Left-sided failure is also indicated by the reduced cardiac index. The heart is not able to get the fluid out to the body.
3. What role did atrial fibrillation play in Mrs. K.’s heart failure?
a. This may have been answered in another question, but the atria’s aren’t pumping. In layman’s

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