Salie Mae Fisher Case Study

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

Doe will be referred to the following outpatient services in Jacksonville, FL for assistance with dyspnea and fatigue; Brooks Rehabilitation, Home Watch Caregivers, and UF Health Cardiac Rehabilitation Program. Brooks Rehabilitation offers a Cardiac Disease Management Program that works through the case management action plan to ensure the patient is managing his condition. Brooks Home Care Advantage Physical Therapy offers patient’s world class care to help them achieve full mobility and independence (Brooks Rehabilitation, 2014). Home Watch Caregivers offer support for patients living alone with chronic health conditions. The personalized care plans will be implemented to meet the goals of the case management action plan and encourage the patient to commit to a healthier lifestyle.

Jonathan is a 63-year-old man, born on August 23rd, 1956 and lives with his eldest son. He was married two times and has three children, two children from his first marriage and one from his second. He lives in northern Ontario but originally was from southern Ontario, he moved here shortly following his second divorce. He is of Italian decent and is a practicing Catholic. The patient’s weight is 95 kilograms; he is 178 centimeters tall and has a body mass index (BMI) of 28.3. Jonathan says he smokes around one pack of cigarettes a day, does not exercise enough and eats fast food a few times a week. The patient now has congestive heart failure as a consequence of his myocardial infarction (MI) or heart attack. He was transferred from another hospital in the beginning of November and was waiting for more tests to be completed before he could be discharged. Jonathan has some known comorbidities that can exacerbate his CHF, this includes smoking, obesity, and noncompliance with medications.

Heart failure affects nearly 6 million Americans. It is the leading cause of hospitalization in people older than 65. Roughly 550,000 people are diagnosed with heart failure each year (Emory Healthcare, 2014). Heart failure is a pathologic state where the heart cannot pump enough blood to meet the demand of the body’s metabolic needs or when the ventricle’s ability to fill is impaired. It is not a disease, but rather a complex clinical syndrome. The symptoms of heart failure come from pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Individuals experience orthopnea,

Providing patients diagnosed with Congestive Heart Failure effective teaching can eliminate reoccurring hospitalizations. Patients are discharged with CHF and readmitted within 30 days. The information provided will examine the process of enhancing patient knowledge and provide additional resources essential for effective health care management. Research evidence provides data that proves patients who are diagnosed with CHF needs a variety of health care needs during admission and after discharge. The proposal will display an evaluation plan, implementation plan and a dissemination of the

An elder lives a healthier, active, and stable life when provided proper care. There are many physical and psychological changes occur during the process of aging. Sally Mae Fischer is an elderly individual, living alone and has chronic and acute health issues. This paper will identify, prioritize, and describe four problems, provide assessment data, nursing interventions, and rationale for the interventions. A nurse to patient script will also be provided detailing patient teaching and follow up.

A resident at the time saw that although there is a hearty amount of evidence that illustrates that adhering to heart failure guidelines decreases the rate of mortality and morbidity, nationally there is modest adherence to heart failure practice guidelines. Doctors have voiced a multitude of reasons to this poor participation including but not limited to time constraints in a visit, inertia of patterns in practice, lack of awareness and lack of acceptance are a few. This new web-based tool, the “Smart” Heart failure sheet is designed to help connect previously compartmentalized information. It seeks to link guidelines to their patients’ clinical and laboratory characteristics and systematize adherence to heart failure guidelines. It accomplishes this by uploading pertinent patient-specific data, including laboratory and imaging results, procedure reports and relevant medications. Additionally it also provides tools, such as a flow chart for diuretic dosage and weights. Overall this tool is useful to help physicians identify patients who may benefit from a treatment. From there it provides support tools that alert the physician to a personalized medical treatment. The “Smart” Heart Failure Sheet acts as a registry for scholarly research and also provides educational resources to expand providers’ knowledge, thereby improving patient care (Battaglia,

* I: Monitor for symptoms of heart failure and decreased cardiac output. Listen to heart sounds, lung sounds and note flowing symptoms: dyspnea, orthopnea,

Therapeutic measures for a patient with congestive heart failure would be daily weights, dietary sodium restrictions, positioning in high or semi-Fowler’s position, frequent vital signs, oxygen by cannula or mask, medical devices: pacemakers, internal cardiac defibrillator, biventricular cardiac pacemaker, ventricular assist device, medications: digoxin, diuretics, inotropes, nesiritide, beta blockers, surgery: heart valve repair or replacement, coronary

Nurses should take care to select the proper outcomes to ensure optimum care is provided to patients with CHF. The plan of care is dependent on the nursing diagnosis and the desired nurse-sensitive outcomes. The priority NOC outcome for the diagnosis of CHF is Fluid Balance and Fluid Overload Severity. Other related NOC outcomes are Knowledge: Cardiac Disease Management, Knowledge: Energy conservation, Knowledge: Medication, Knowledge: Prescribed Activity, Knowledge: Treatment, and Knowledge: Weight Management (Johnson et al., 2012). These are only a select few of the multiple outcomes available; care should be modified as the disease progresses through the problems which evolves over the lifetime of patients diagnoses with CHF. Once all these determinants are established, the nurse will be prepared to determine which level of NOC is essential to effectively manage the disease.

Dealing with Mrs. Smith’s nursing diagnosis of decreased cardiac output related to cardiac dysfunction, I would educate her on common signs and symptoms of heart failure exacerbations and appropriate actions she must take if she becomes symptomatic again. Common symptoms of a heart failure exacerbation may include fatigue, shortness of breath, swelling in legs, ankles, and feet, reduced ability to exercise, persistent cough/wheezing, three to five pound weight gain overnight, and chest pain. I would explain to Mrs. Smith the importance of daily exercise, because in a study performed it showed that 91% of women did not exercise for fear that they would hurt themselves or increase their symptoms (Stamp, 2011). It is important to exercise daily to reduce living a sedentary lifestyle, while also knowing your limitations with your heart failure. Mrs. Smith who lives by herself and mostly eats TV dinners is at risk for exacerbating her factors related to her high sodium intake. It is important in this step to get a TV dinner box and a couple canned foods and educate her on the importance of looking at the sodium content in each meal that she

According to the Heart Foundation (2010), “Best-practice management of chronic heart failure (CHF) involves multidisciplinary care” (p. 3). A care coordinated with his different physicians including cardiologist, pulmonologist, and referring physicians, as well as clinical nurses, and dieticians will be an important step in Mr. P’s CHF care. As they are concerned about the mobility outside of their home, a telephonic follow-up after discharge from the hospital, and door delivery of medicines could be beneficial. It is also very important to help him to overcome his polypharmacy. Since Mrs. & Mr. P seem emotionally weak, they need emotional support to cope up with the situation. They are worried about the heaping medical bills. Provide information about the possibility of getting qualified for Medicaid/Medicare as well as grants from organizations like Patient Access Network

Your patient is similar to my patient. They both have a good experience with home health, and both of them are proactive to their health. They follow all the regimens and keep in track with their medications.

Congestive heart failure is a chronic disease that requires daily monitoring and life style management. Affecting the elderly, and their family the adjustment is a challenge. Daily life skills include the monitoring of daily weights, intake and output, and a low sodium diet. The person with congestive heart failure is generally admitted to the hospital for medication adjustments when their symptoms increase. The patient is often times short of breath, with a decrease in energy and an increase in their weight. The patients are generally elderly 60-65 years of age or older, and when comparing African Americans to Caucasians the African Americans have a 1.5 greater chance of developing heart failure ("Heart Failure," 2017). The

Based on the patients physical exam, social activities, family history, recent laboratory results and imaging; from a nurse practitioner stand point I am concerned that the patient has coronary artery disease, new onset of congestive heart failure, as well as concerns that the patient may be suffering from depression. Mr. E. W. is an obese African-American male and has uncontrolled hypertension. Given Mr. E. W’s ethnicity, obesity and uncontrolled hypertension he is a likely candidate for coronary artery disease. The patient also presents with an ejection fraction of 46% and a prominent S3 sound upon auscultation. These findings are indicative of congestive heart failure. I am also concerned about the patient’s psychological well-being. The patient openly admits to drinking “several beers every evening to relax,” and is said to be a widower who lives alone. The patient also admitted to not speaking to his daughter for the past 4 years after she moved out with her aunt. These are signs and symptoms of depression coupled with poor coping strategies from tragic life events (CDEM Curriculum).