Question

jeraldine yates is a 70 year old woman originally from alabama . she lives alone and is avle to manage herslef independently. she is active in jer community and church . mrs yares was admitted to the hosptial teo months ago with heart failure

Answer 1

Mrs. Yates is a 70 yr old woman who lives in a local rest home. She is able to do most of his activity of daily living independently. She has a history of congested heart failure. Her ankles are very "and they are very achy too". you walk her to the hallway (10mtrs) and noticed that she becomes very short of breath, and she must sit down to catch her breath. Her SaO2 is 95%, on auscultating her lung crackles are heard the left and right lungs.?

1. Which assessment findings are considered with CHF?

Ankles are swollen, oedema, very short of breath, lung crackles

2. What else you be assessed for this time?

weight, fluid intake, vital signs

3.

3a. Explain how CHF results in each of the assessment in question 1, explain which ventricle is involved and indicate either backward or forward effect?

CHF begins when the heart can no longer maintain effective CO usually caused by CAD, hypertension. This will result in low CO, BP, renal perfusion. This stimulates the compensatory mechanisms: SNS activation stimulates increase the release of adrenalin/noradrenalin results to increase HR, myocardial contractility, vasoconstriction and increase BP. However, this also increases venous return to the heart which worsens the ventricular performance because the heart is already overload. Neurohormonal response: When decrease CO there will be low blood flow in the kidney which stimulates the activation of RAAS system results in increased peripheral vasoconstriction. It also leads to sodium and water retention because of the release of aldosterone. This will end up in volume overload causing oedema.

3b.From the symptoms, explain which ventricle is involved and indicate either backward or forward effect.?

Failure of LV causes the blood back up to LA and to pulmonary circulation resulting in increased pulmonary pressure causing pulmonary oedema, shortness of breath and lung crackles. Failure of RV causes the blood flows back to the systemic circulation. This results to increase volume and pressure in RA, superior and inferior vena cava and accumulation of fluids in systemic capillary bed resulting in peripheral oedema that is why her ankles are swollen.

3c. What are Mrs Yates current medications?

EC Aspirin 80mg daily, Clopidogrel bisulfate (Plavix) 75mg daily, Lisinopril 20 mg daily, Carvedilol