Case Study 1
Heart Failure
M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge.
1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? The patient most likely failed to adequately apply the fluid and sodium restrction diet properly. Upon discharge
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Answer: A, B, C
Case Study Progress:
After reviewing M.G.’s medications, the physician writes these medication orders:
Chart View:
Medication Orders: Enalapril (Vasotec) 5 mg po bid Carvedilol (Coreg) 100 mg po every morning Glipizide (Glucotrol) 10 mg po every morning Furosemide (Lasix) 80 mg IV push now, then 40mg/day IVP Potassium Chloride (K-dur) 20meq/day po
4. What is the rationale for changing the route of the furosemide (Lasix)? b. IV drugs work more quickly than drugs by PO. The Lasix (a diuretic) is used in patients with CHF due to the drugs ability to remove fluids from the body via the kidneys. When given IV, the patient begins to experience diaphoresis, providing the patient quick symptomatic relief. In this particular patient, she is still gaining weight on a weekly basis so it is imparative that the fluids be reduced in the body, to help in relief of the CHF.
5. You administer furosemide (Lasix) 80mg IVP. Identify three parameters you would use to monitor the effectiveness of this medication. c. Log of daily weight to see if patient is losing weight appropriately d. Decrese in pitting edmea (if present) and decrease in adventitious lung sounds. e. Decrease in Blood Pressure
6. What laboratory tests should be ordered for M.G. related to the order for furosemide (Lasix)? (Select all that apply) f. Magnesium level g. Sodium level h. Complete blood count
Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of
M.G., a “frequent fl ier,” is admitted to the emergency department (ED) with a diagnosis of heart failure
M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last
2) Under the effects of Lasix Mr. Underhill’s body was prevented from absorbing to much salt, which instead was directed straight to the urine quickening the process of dehydration in the body.
8. If the biochemical test requires an incubation of 24 hours, what do you need to do? (1 pt)
This week, I was given the opportunity to care for two female patients – 205(1) and (2). The first patient, 205-1, was admitted with respiratory distress and had a past medical history of hypertension, schizophrenia and bipolar disorder. She was initially put on 2 L/min of oxygen and placed on oxygen titration protocol with orders to maintain O2 saturations between 88-92%. The patient was oriented to person and place, but had difficulty with time. She was also obese (BMI 30) and deemed a moderate assist with ambulation. Her care plan included total assistance with ADLs, smoking cessation and oxygen protocols, limited salt intake (3mg), and chronic pain management. The second patient, 205-2, was admitted with a right pelvic fracture and had
11. You tell J.M the combination of high sodium foods he had during the past several days, might have contributed to his present episode of Heart Failure, he looks surprised. J.M said “ but I didn’t add any salt to them”. To what health care professional
The Estroga has not had money to purchase medications, groceries, doctors’ visits or the transit system. On June 12th Rebecca visited with Mrs. Estroga and she noticed her blood glucose machines was reading “high numbers”. The highest the machine will read is 600 and over 600 it will state “high numbers”. Rebecca suggested Ms. Estroga go to the emergency room, but Ms. Estroga refused. Previously on June 10th Mrs. Estroga had seen Dr. Arthel, but due to financial problems she was unable to purchased medications. Mrs. Estroga was admitted into the hospital sometimes between June 19th and June 26th. According to Rebecca she did not know when Mrs. Estroga was released, but she was on her work list to be seen on June 26th. Mrs. Estroga did have other medications waiting to be picked up from the pharmacy, but she did not have the
Congestive heart hailure, also known as CHF or heart failure, affects the lives of 5 million Americans each year with 550,000 new cases diagnosed yearly. (Emory healthcare, 2013) CHF is a medical condition in which the heart has become weak and cannot pump enough blood to meet the need for oxygen rich blood required by the vital organs of the body, less blood is pumped out of the heart to the organs and tissues in the body and pressure in the heart increases, it does not mean the heart has stopped working. (Murphy, 2013) Once the heart has become weakened by conditions such as hypertension, abnormal heart
Mr. Bellows is an overweight, 51-year-old with a long history of angina. He is known to your hospital and arrives in an ambulance with more severe symptoms than previous admissions. Mr. Farmer informs the ambulance crew, the Anginine tablets he has taken, have not provided any symptom relief.
Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.
Discuss the roles of medications, ICS for long term anti-inflammatory effect and Beta adrenergic for immediate bronchial dilation.
Patient Sallie Mae Fisher was released from the hospital last Saturday. This patient is eighty two years old and lives alone as her daughter lives too far away to be helpful. Her medical history includes chronic congestive heart failure (CHF), atrial fibrillation (AF), and hypertension (HTN). She has been hospitalized four times for CHF exacerbation in the last six months. She was discharged from the hospital after being there three day to treat increased dyspnea, an eight pound weight gain, and chest pain. This paper will identify, prioritize, and describe at least four problems with evidence for each problem and identify at least four medical or nursing interventions with rationale for the interventions included.
In year 2000 and 2010, an estimated 1 million hospitalizations for Congestive Heart Failure (CHF), of which most of these hospitalizations were for those aged 65 and over, the share of CHF hospitalizations for those under age 65 increased from 23% to 29% over this time period (Hall, Levant, & DeFrances, 2012). According to Held (2009), acute decompensated heart failure (ADHF) ensues when cardiac output fails to meet the demand of the body’s metabolic needs. The fluid volume overload makes the unstable condition necessitates instant treatment for the reason that it impairs perfusion to systemic organs, endangering their function.
Drug therapy consists of; Lasix, antihypertensives, antiemetics, H-2 blockers, erythropoietin, vitamins and electrolyte balancing agents (phosphate, calcium, V-D, Vit-B, and amino acids. Dialysis is mostly the patient’s only way of survival. Nutritional therapy is encouraging patients to avoid ↑Ca and ↑ protein foods. Fluid restriction is important since the kidneys have a difficult time excreting. If left untreated the patient would essentially die. The fluid overload combined with the toxicity of the left over wastes would shut down the body’s organs and death would occur.