Question

CLIENT PROFILE Jeraldine Yates is a 70-year-old woman originally from Alabama. She lives alone and is able to manage herself independently. She is active in her community and church. Mrs. Yates was admitted to the hospital two months ago with heart failure. Since her discharge, a visiting nurse visits every other week to assess for symptoms of heart failure and see that Mrs. Yates is continuing to manage well on her own. CASE STUDY The visiting nurse stops in to see Mrs. Yates today. The nurse immediately notices that Mrs. Yate's legs are very swollen. Mrs. Yates states, "I noticed they were getting a bit bigger. They are achy too." The nurse asked Mrs. Yates if she has been weighing herself daily to which Mrs. Yates replies, "I got on that scale the last time you were here, remember?" The nurse weighs Mrs. Yates and she has gained 10 pounds. Additional assessment findings indicate that Mrs. Yates gets short of breath when ambulating from one room to the other (approximately 20 feet) and must sit down to catch her breath. Her oxygen saturation is 95% on room air. Bibasilar crackles are heard when auscultating her lung sounds. The nurse asks Mrs. Yates if she is currently or has in the past few days experienced any chest, arm, or jaw pain or become nauseous or sweaty. Mrs. Yates states, "No, I didn't have any of that. I would know another heart attack. I didn't have one of those." The nurse asks about any back pain, stomach pain, confusion, dizziness, or a feeling that Mrs. Yates might faint. Mrs. Yates denies these symptoms stating, "No. None of that. Just a little more tired than usual lately." Her vital signs are T 97.6F, BP 140/70, HR 93, RR 22. The nurse reviews Mrs. Yate's list of current medications. Mrs. Yates is taking aspirin, clopidogrel bisulfate, Lisinopril, and carvedilol. The nurse calls the health care provider who asks the nurse to draw blood for a CBC, BMP, troponin, BNP, creatine kinase, and albumin. The health care provider also prescribes oral furosemide and asks the nurse to arrange an outpatient ECG, EKG, chest x-ray, and echocardiogram. QUESTIONS 1. Which assessment findings during the nurse's visit are consistent with heart failure? 2. Explain what the following terms indicate and include the normal values: cardiac output, stroke volume, afterload, preload, ejection fraction, and central venous pressure. 3. Heart failure can be classified as left or right ventricular failure, systolic versus diastolic, according to the New York Heart Association and using the American Heart Association guidelines. Explain these four classification systems and the signs and symptoms that characterize each. 4. The nurse arranges for Mrs. Yates' son to be present at the next home visit so that the nurse can teach both about proper dietary choices and fluid restrictions. List five points of information that the nurse should include in the teaching. 5. Since changing her diet, Mrs. Yates has responded to her outpatient treatment plan and has noticed marked improvement in how she feels. The nurse wants to make sure that Mrs. Yates understands the importance of monitoring her weight. That instructions should the nurse give Mrs. Yates regarding how often to weigh herself and what weight change should be reported to her health care provider or the nurse?

Answer 1