Question

Mr. Jackson refuses to settle in bed, preferring to sit in the bedside recliner in high-Fowler’s position. He states, “Lately, this is the only way I can breathe.” Mr. Jackson states that he has not been able to work in his garden without getting short of breath. He complains of his shoes and belt being too tight. When Mr. Jackson’s nurse, Ms. Takashi, RN, obtains his nursing history, Mr. Jackson insists that he takes his medications regularly. He states that he normally works in his garden or light exercise. In his diet history, Mr. Jackson admits a fondness for bacon and Chinese food and sheepishly admits to snacking between meals “even though I need to lose weight.”Mr. Jackson’s vital signs are BP 95/72 mmHg, HR 124 bpm and irregular, R 28/min and labored, and T 97.5°F (36.5°C). The cardiac monitor shows atrial fibrillation. An S3 s noted on auscultation; the cardiac impulse is left of the midclavicular .

line. He has crackles and diminished breath sounds in the bases of both lungs. Significant jugular venous distention, 3+pitting edema of feet and ankles, and abdominal distention are noted. Liver size is within normal limits by percussion. Skin cool and diaphoretic. Chest x-ray shows cardio-megaly and pulmonary infiltrates.

Questions:

Provide 3 nursing diagnosis for Mr. Jackson

Provide 3 Expected Outcomes of nursing care

The crackles on the exam indicate left or right side heart failure?

The pitting edema is indicative of left or right side heart failure?

Atrial fibrillation puts Mr. Jackson at risk for what other pathologies to occur? And Why? (name 2)

What about Mr. Jackson’s diet can further his cardiovascular disease and why?

Answer 1

ANSWER

* Three nursing diagnosis for Mr.Jackson

                     * Activity intolerance related to decreased cardiac output.

                     * Excess fluid volume related to heart failure syndrome.

                     * Anxiety related to breathing difficulty from inadequate oxygenation.

* Three expected outcomes of nursing care.

                     * Maintain adequate oxygen level in the body.

                     * Relieving fluid overload symptoms.

                     * Promote the activity level of patient and reduce anxiety due to disease condition.

* Crackes in all lung fields on exam indicate left heart failure.

* Pitting edema on exam indicate right heart failure.

* Atrial fibrillation leads to

                  * Cardiomyopathy

                  * Stroke.

                  * Heart failure.

* Above pathologies are due to pooling of blood in the heart due to atrial fibrillation which result in

clot formation and the moving clots obstruct blood vessels leads to sytemic complications like

stroke and cardiovascular diseases.

* Mr. jackson diet plan include,

                   * Avoid saturated fat containing foods which increases the risk of cardiovascular diseases

                      by increasing cholesterol level.

                   * Include fruits and vegetables in diet plan to get enough nutrients for the normal functioning

                      of heart.

                   * Good fat containing foods like nuts,salmon,olive oil can include in diet plan.

                   * Avoid use of high sodium foods (processed or canned foods) which alter normal

                     functioning of heart.

  

           

Answer 2

because the heart is pumping properly that why overload of fluid build in the lungs and heard to breath that why sitting position helps to reduce venous return in patients with heart failure