CS Heart Failure case study (JoAnn Smith, 72 years old)

Primary Concept Perfusion Interrelated Concepts (In order of emphasis) 1. Gas Exchange 2. Fluid and Electrolyte Balance 3. Clinical Judgment 4. Patient Education 5. Communication 6. Collaboration UNFOLDING Reasoning Case Study: STUDENT Heart Failure History of Present Problem: JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and systolic heart failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. She presents to the emergency department (ED) for shortness of breath (SOB) the past three days. Her shortness of breath has progressed from SOB with activity to becoming SOB at rest. The last two nights she had to sleep in her recliner chair to rest comfortably upright. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse. She has noted increased swelling in her lower legs and has gained six pounds in the last three days. She is being transferred from the ED to the cardiac step-down where you are the nurse assigned to care for her. Personal/Social History: JoAnn is a retired math teacher who is unable to maintain the level of activity she has been accustomed to because of the progression of her heart failure the past two years. She has struggled with depression the past two years and has been more withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction. What data from the histories is RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: MI four years ago, MI is significant because it decreases heart function due to death of increase shortness of breath at rest; can only myocardial muscle speak in partial sentences, EF of 15% shows that the heart is having a hard time pumping blood out to ischemic cardiomyopathy with EF of 15% rest of the body therefore starving it of oxygenated blood. last two nights slept in recliner Weight gain and increased swelling signifies she is fluid overloaded and it increased swelling in lower legs can be reason why she is having a hard time talking, breathing, being gained 6 pounds in last 3 days active and why she has to sleep in a recliner the past 2 nights RELEVANT Data from Social History: Clinical Significance: Retired math teacher, recent widow, history of Depression might affect her enthusiasm to recover, to stick to a therapy depression, decreasing activity level regimen What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition? Draw lines to connect) PMH: Home Meds: Pharm. Classification: Expected Outcome:  Diabetes mellitus type II 1. ASA 81 mg PO daily  Antiplatelets  Decrease chance of  Hypertension 2. Carvedilol 3.25 mg PO  Beta blocker clot formation  Atrial fibrillation daily  ACE inhibitor  Decrease blood 3. Lisinopril 5 mg PO  Cholesterol pressure  Hyperlipidemia daily medication  Decrease blood  Chronic renal insufficiency 4. Ezetimide 10 mg PO  Vasodilator pressure, helps with (baseline creatinine 2.0) daily  Diuretic heart failure,  Cerebral vascular accident  Electrolyte decrease chance of 5. Hydralazine 25 mg PO (CVA) with no residual 4x daily replacement death from heart deficits 6. Torsemide 20 mg PO  Anticoagulant attack  Antidiabetic  Decrease  Heart failure (systolic) bid cholesterol secondary to ischemic 7. KCL 20 meq PO daily  Decrease blood cardiomyopathy 8. Warfarin 5 mg PO daily pressure  MI with stent x2 to LAD 4 9. Glyburide 5 mg PO  Decrease swelling, years ago daily decrease fluid overload  Increase serum potassium