Question

Write a nursing care plan for this case study following the rubric

Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three myocardial infarctions in the last 10 years, he has decreased left ventricular function. Mr. Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he presents to the emergency department with fatigue, generalized weakness, and feelings of “skipping” heartbeats. Upon arrival, he is placed on the cardiac monitor, his vital signs are assessed, and an IV is inserted. He currently denies chest pain, but is experiencing some shortness of breath, and is placed on 2 L of oxygen via nasal cannula.

NURSING CARE PLAN RUBRIC

Do not write the NCP using a grid format… use an essay format/ bullet point using the numbers of this rubric.

All NCP will be graded according to the following rubric.

1) Definition of the medical diagnosis __________10

etiology/pathophysiology

2) Common signs and symptoms ___________5

3) Potential complications ___________5

4) Head to toe physical assessment you are to write one….use the data in the case if there is none you create it as if this was your patient. ____________10

5) Diagnostic and lab studies ___________5

normal values

expected abnormalities

6) ALL NANADA Nursing diagnoses __________10

7) Develop 3 NANDA priority nursing diagnoses __________10

8) State a patient plan AND goal for each of the __________10

priority nursing diagnosis

9) Write interventions for each of __________10

priority nursing diagnosis

10) Write scientific rationales for you you ___________5

interventions

11) Write evaluation of your interventions __________10

your plan or make changes

12) List of typical medications __________10

category

usual dosage

side effects

patient teaching

Answer 1

CONGESTIVE HEART FAILURE:

cardiac heart failure is a progressive clinical syndrome caused by the inability of the heart to pump sufficient blood to meet the body's metabolic needs .heart failure may be primarily due to systolic dysfunction or diastolic dysfunction.

ETIOLOGY AND PATHOPHYSIOLOGY:

Systolic dysfunction

Causes of systolic dysfunction(decreased contractility ) are reduced muscle mass, dilated cardiomyopathies, and ventricular hypertrophy .ventricular hypertrophy can be caused by pressure overload.or volume overload.

diastolic dysfunction:

The ventricular wall is thickened and unable to relax properly during diastole ventricular filling is impaired because of which output is low.it occurs in sustained hypertension, aortic stenosis, congenital heart disease, A-V Shunt, hypertrophic cardiomyopathy.

The leading cause of HF is coronary artery disease and hypertension.

Decreased cardiac output results in activation of compensatory responses to maintain circulation

1)tachycardia and increased contractility through sympathetic nervous system activation.

2)frank starling mechanism whereby increased preload increases stroke volume.

3)vasoconstriction.

4)ventricular hypertrophy and remodeling.

Although these compensatory mechanisms initially maintain cardiac function, they are responsu=ible for the symptoms of heart failure and contribute to disease progression.

SIGNS AND SYMPTOMS:

The patient presentation may range from asymptomatic to cardiogenic shock.

primary symptoms are dyspnea and fatique which lead to exercise intolerance.

other pulmonary symptoms include orthopnea, paroxysmal nocturnal dyspnoea, tachypnea, and cough.

fluid overload can result in pulmonary congestion and peripheral edema.

nonspecific symptoms include fatigue, nocturia,hemoptysis,abdominal pain,anorexia,nausea,bloating ,ascites,poor appetite or early satiety,mental status changes,and weight gain.

PHYSICAL ASSESSMENT :

Physical examination findings include:

pulmonary crackles, S3 gallop, cool extremities, Cheyne stokes respiration, tachycardia, narrow pulse pressure, cardiomegaly, symptoms of pulmonary edema(extreme breathlessness, and anxiety, sometimes with coughing and pink, frothy sputum), peripheral edema, jugular venous distention, hepatojugular reflux, and hepatomegaly.