Question

Melissa White is a 67-year-old female with ischemic cardiomyopathy and a history of chronic heart failure, HTN, high cholesterol and coronary artery disease (CAD). She is a past smoker that quit 5 years ago after her husband died of emphysema in 2007. She is a retired school teacher who cares for her ailing 90-year-old mother at home. Her neighbor brought her to an emergency department because she was complaining of shortness or breath, fatigue and swelling in her ankles and feet. Patient states that her shortness of breath is especially prominent at night and when walking. Physical examination revealed mild respiratory distress and 2+ pitting edema. Serum Creatinine level was 1.0. Upon questioning the patient about the events leading up to this morning, she ??a?ed ?ha? ?he did n?? ?ake he? ??a?e? ?ill? f?? ?he la?? fi?e da?? beca??e he? m?m?? ankle? ?e?e ???llen ?? ?he ga?e he? ?he ?ill?. She al?? admi??ed ?? being ??? ?f ??ne ?f m? hea?? ?ill?? b?? cann?? ?emembe? ?hich ?ne. She ??a?e? ?he i? ?n ?e?e?al heart medications. She has not brought any of her medication with her to the ED. 12-lead EKG revealed sinus

tachycardia without ectopy. Her chest radiography showed borderline cardiomegaly. An ABG was drawn and the results are pending. A saline lock was inserted into left forearm and she was admitted to the telemetry unit. She is allergic to penicillin, cephalosporin, and midazolam.

1. What are the abnormal assessment findings for this patient?

2. Develop 2 priority nursing diagnoses (3-part phrases) for this patient.

3. What is 1 at risk nursing diagnosis for this patient?

4. What is one goal for this patient?

Answer 1

So the patient had ischemic cardiomyopathy abnormal findings include shortness of breath, fatigue, pitting edema over ankles, heart palpitation or tachycardia etc.

Nursing diagnosis

1, Decreased cardiac output related to altered blood supply to heart as manifested by palpitation.

As the blood flow through coronary arteries decreased heart muscles become weak and decrease the blood supply from heart

2, Excess fluid volume related to fluid retention as manifested by pitting edema on ankle.

As the blood supply to body especially to renal artery decreases kidney activate renin angiotensin mechanism. Which increases the retention of water and edema occur.

Risk for impaired gas exchange related to cardiomyopathy

Goal

Patient will maintain adequate cardiac output and decreased episodes of fatigue, palpitation and shortness of breath.