Heart Failure Case Study with Answers (23 Solved Questions)

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Heart FailureJoAnn Smith, 72 years oldPrimary ConceptPerfusionInterrelated Concepts(In order of emphasis)1. Gas Exchange2. Fluid and Electrolyte Balance3. Clinical Judgment4. Patient EducationFUNDAMENTAL Reasoning: STUDENTHistory of Present Problem:Heart Failure

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JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and systolic heartfailure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. She presents to theemergency department (ED) for shortness of breath (SOB) the past three days. Her shortness of breath has progressedfrom SOB with activity to becoming SOB at rest. The last two nights she had to sleep in her recliner chair to restcomfortably upright. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse.She has noted increased swelling in her lower legs and has gained six pounds in the last three days. She is beingtransferred from the ED to the cardiac step-down where you are the nurse assigned to care for her.Personal/Social History:JoAnn is a retired math teacher who is unable to maintain the level of activity she has been accustomed to because of theprogression of her heart failure the past two years. She has struggled with depression the past two years and has beenmore withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction.What data from the histories is RELEVANT and has clinical significance to the nurse?RELEVANT Data from Present Problem:Clinical Significance:Systolic hearth failureIschemic cardiomyopathyEjection fraction of 15%Increased SOB, even at restSpeak in partial sentencesIncreased edema in legsGained six pounds in last 3 daysHer heart is not pumping blood to the tissues and organs as it shouldHer heart muscle was damaged and is weakened, probably due to her MIfour years agoEjection fractions should be above 50%; her heart is doing a poor job atpumping out blood to her bodyIt is not normal to be SOB, especially at rest; her lungs are strugglingShe is so short of breath that she can not even speak without stopping tobreatheIncreased edema means that fluid is stuck in third spaces in the tissue (notis the vascular system or the cells, but in between)Gaining weight is a sure sign of fluid retentionRELEVANT Data from Social History:Clinical Significance:Unable to maintain level of activityDepression past two yearsShe is unable to properly care for herself or perform ADL’s if she gets soout of breathDepression slows the healing process, especially when patients are lesslikely to comply with therapiesDeveloping Nurse Thinking by Identifying Significance of Clinical Data

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Current VS:P-Q-R-S-T Pain Assessment (5th VS):T:98.6 F/37.0 C (oral)Provoking/Palliative:P:92 (irregular)Quality:Denies PainR:26 (regular)Region/Radiation:BP:162/54 MAP: 90Severity:O2 sat:90% (6 liters n/c)Timing:What VS data is RELEVANT and must be recognized as clinically significant by the nurse?RELEVANT VS Data:Clinical Significance:Pulse of 92Respiration rate of 26BP of 162/54O2 sat 90% on 6 liters NCAlthough within normal rang, her pulse is still on the higher end and causingher heart to work harderShe is breathing quickly because her lungs are hungry for air and want moreO2 to send to the tissuesBP is higher than normal, which is putting more strain on her heartOxygen levels are unable to be kept in a therapeutic range, even with theassistance of O2

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Current Assessment:GENERALAPPEARANCE:Appears anxious, restlessRESP:Breath sounds have coarse crackles scattered throughout both lung fields ant/post, laboredrespiratory effort, patient sitting uprightCARDIAC:Rhythm: atrial fibrillation, pale, cool to the touch, pulses palpable throughout, 3+ pittingedema lower extremities from knees down bilaterally, S3 gallop, irregular, no jugular venousdistention (JVD) notedNEURO:Alert and oriented to person, place, time, and situation (x4)GI:Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrantsGU:Voiding without difficulty, urine clear/yellowSKIN:Skin integrity intact, skin turgor elastic, no tenting presentWhat assessment data is RELEVANT and must be recognized as clinically significant by the nurse?RELEVANT Assessment Data:Clinical Significance:Appears anxious, restlessCoarse crackles in both lungsLabored respiratory effort, sitting upIn atrial fibrillationPale, cool skinEdema in lower extremities (3+)S3 gallop, irregular pulseIt is obvious she is uncomfortable and possibly scared; sometimes anxiety cancause more breathing issues; the nurse should be there to support and comfortthe patientCrackles can indicate that there is fluid buildup in the lungsShe is having a hard time breathing, and needs to sit up to be able to breathemore easilyAtrial fibrillation can attribute to the ventricle being unable to fill with blood asthey normally shouldPale, cool skin is an indicator that there is poor tissue perfusionEdema indicates that there is fluid buildup, or third spacing in the extremities;the nurse needs to try to determine why this is happeningS3 occurs from the blood swishing back against the valves; irregular pulses canoccur from an alteration in the electrical system of the heart due to stretchingRadiology Reports: Chest x-rayWhat diagnostic results are RELEVANT and must be recognized as clinically significant by the nurse?RELEVANT Results:Clinical Significance:Bilateral diffusepulmonary infiltratesconsistent withpulmonary edemaThere is a fluid buildup in the lungs that is causing infiltration and edema in the lungs; thismakes it harder for gas exchange to occur in the alveoli

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