Question

Nursing/homework Case Study: please no handwriting, use only Nursing peer reviews/ nursing research, nursing books only must reference and citations

Day 1    

A 47 year old female arrives at the emergency department complaining of shortness of breath for the past three days which has gotten progressively worse. Her shortness of breath is worse when lying down and with exertion. She complains of a cough, especially at night. The patient also notes increased swelling in her legs bilaterally and well as mild substernal chest pressure.

The patient has a history of hypertension, diabetes and a prior myocardial infarction. Her vital signs are as follows: BP 210/106, HR 118, RR 26, T 98.2. On exam you note rales in the lung bases bilaterally as well as 1+ pitting edema in the lower extremities bilaterally. The patient is sitting up and in no acute respiratory distress. Her oxygen saturation is 94%.

Day 2

Vital signs 180/96, HR 120, RR 24, Temp 98.0, Pulse Ox 92%, The patient is still edematous and short of breath. Patient states she still feels the same.

Day 3

Vital signs 156/81. HR 99, RR 20, Temp 97.9, Pulse Ox 94%. The patient has less edema, and shortness of breath. She feels better and she is able to walk to the bathroom with assistance.

What is CHF?

What is right sided heart failure? How does it manifest? What is left sided heart failure? How does it manifest?

What are the causes or risk factors for CHF?

What medications would you expect this patient to be prescribed? Complete a drug card for EACH medication you believe can be prescribed for this patient (the drug card can be found under the files section of this course).

Answer 1

Ans) Congestive heart failure (CHF): Inability of the heart to keep up with the demands on it, with failure of the heart to pump blood with normal efficiency. When this occurs, the heart is unable to provide adequate blood flow to other organs, such as the brain, liver, and kidneys.

Right-sided heart failure means that the right side of the heart is not pumping blood to the lungs as well as normal. It is also called cor pulmonale or pulmonary heart disease.

Manifestation for right sided heart failure:

- Ascites peripheral edema, heptomegaly; RUQ pain, splenomegaly, JVD, anorexia.

Left-sided heart failure is defined not as a disease, but a process. When diastolic heart failure occurs, the left ventricle has grown stiff or thick, and it is unable to fill the lower left chamber of the heart properly, which reduces the amount of blood pumped out to the body.

Manifestation of left and right sided heart failure:

- DOE/PND, SOB, rales, cough, oliguria/nocturia, confusion/anxiety, tachycardia, fatigue, pale, cool, clammy skin.

Left-sided heart failure	Fluid may back up in your lungs, causing shortness of breath.
Right-sided heart failure	Fluid may back up into your abdomen, legs and feet, causing swelling.

Causes or risk factors for CHF:

- Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits (plaque) in your arteries, which reduce blood flow and can lead to heart attack.

- CAD, age, hypertension, obesity, cigarette smoking, diabetes mellitus, high cholesterol, african american descent are the risk factors for CHF

Drugs that can be prescribed for CHF:

- ACEI, ARBs, combo: hydralazine/isosorbide dinitrate, beta-blockers, diuretics, digoxin, Ca++ channel blockers.

- Volume overload (congestion) and myocardial dysfunction (heart failure). Diuretics can be used to treat volume overload. Positive inotropic agents (e.g., cardiac glycosides, such as digoxin) are used to directly treat myocardial dysfunction (inotropic agents increase contractility, relief of symptoms but do not improve survival). Currently, agents that act directly on organs and systems other than the heart are more valuable in the long-term treatment of heart failure (e.g., angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β-blockers, and aldosterone receptor antagonists have been shown to reduce mortality). Pharmacological intervention is aimed at reducing preload and afterload.