Case-Study: Chronic Heart Failure

Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

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Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.Case-Study: Chronic Heart Failure Essay

Subjective Data

Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is “running away.”
Reports that she is so exhausted she cannot eat or drink by herself.
Objective Data

Height 175 cm; Weight 95.5 kg
Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin
Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?Case-Study: Chronic Heart Failure Essay

IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

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The heart of congestive heart failure patient is weak and is not able to supply sufficient blood in key body organs. The condition id further accelerated by secondary factors such a as high blood pressure and coronary artery disease which weaken the heart.

Similarly, faulty heart valves, a condition that occurs when the valves between heart chambers do not open properly forcing the heart to work harder to keep the blood flowing correctly also weakens the heart leading to heart failure. Other tertiary factors such as diabetes, severe anemia as well as kidney or liver filature could precipitate to heart failure.Case-Study: Chronic Heart Failure Essay

The symptoms of the disease are easily recognizable such as shortness of breath coughing, swelling feet and ankles, swelling abdomen as well as weight gain. The treatment and recovery require keen supervision and medication that should be regularly maintained failure to which the condition accelerates depending on the seriousness of the disease or factor involved (Stewart et al 2002, pp361)..

Literature review
Heart failure is common among the elderly and financially dependent population. These are often considered a burden to society and therefore given little attention and follow up.

The smaller financially stable population spends a considerable amount on medication and end up under cost and doctor supervision. In a community with limited or few resources there is little or no follow-up for the elderly after heir discharge from hospital.

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This is because most of them often live lone and only receive one visit per week by a nurse. The nurse assesses their needs and ensures that they have taken their medicine. The regulatory and effectiveness of the medication depends on the patients discipline and punctuality in taking it (Ewald et al 2008, pp101).Case-Study: Chronic Heart Failure Essay

The rates of discipline vary and depend on how the patient perceived the instruction on medications. This therefore poses a problem of taking medications on time. Since most of the patient lives alone, no one will remind them that a puff of cigarette or a sip of wine is a risk factor.

Medical conditions identified as risk factors to congestive heart failure include coronary artery disease, diabetes, hypertension, valvular heart disease, hyperthyroidism and earlier history of heart disease. Apart from medical conditions and age, lifestyle factors such as smoking, excessive consumption of alcohol and continuing use of anabolic steroids are noted as among risk factors of congestive heart failure.Case-Study: Chronic Heart Failure Essay

Statement of the problem
Congestive heart failure contributes to a high number of readmission cases in elderly patients and accounts to up to a quarter of all hospitalization expenditure.

Medical scientists have noted that congestive heart failure is not only a common indication of hospitalization in elderly patients but is also linked to early deaths and a high immortality rate among these patients (Rosamond Wet al. 2008, pp146).

This study will interrogate the rates of readmission as compared to admission in a local hospital with a bed capacity of 300 patients. The study will only focus on elderly 65 and above regardless of sex, race, ethnicity, socio eco, status in life etc. admitted only with CHF and reasons ranges from non-compliance of med, no diet modification, smoking, and alcohol.

No younger population or any less than 65 y/o. The research will narrow down to the readmission and admission rates for the period between January 2010 and March 2011 as well as the relevant data that will facilitate the development of a case management strategy (Krumholz et al 2000, pp 476).Case-Study: Chronic Heart Failure Essay

Case Studies on Cardiac Function

Case 1
A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin.

Discussion Questions

1. Which type of heart failure (left or right sided) is usually associated with dyspnea?Case-Study: Chronic Heart Failure Essay

Left-sided

What other clinical findings are likely to be present with …show more content…
Causes decreased left ventricular end-diastolic pressure.
Causes reduced central venous pressure.

POTASSIUM – replaces the lost potassium caused by the effects of furosemide.

DIGITALIS – cardiac glycoside.
Promotes diuresis – improved kidney perfusion.

Positive inotropic: increase force and velocity of myocardial contractions to increase stroke volume.

Negative chronotropic: decrease heart rate

Negative dromotropic: decrease automaticity at SA node, AV node, and bundle of His.Case-Study: Chronic Heart Failure Essay

SUBLINGUAL NITROGLYCERIN: nitrate that is used to dilate blood vessels by relaxing the smooth muscles that surround the vessel – especially veins and coronary arteries.

Case 2
K.R. is a 46-year-old man admitted to the emergency department with unremitting chest discomfort. The pain started while he was shoveling snow from his walkway. He had experienced chest discomfort with activity previously, but the pain had subsided with rest and he sought no medical help. This time the pain did not subside and became increasingly severe, radiating to his left arm and lower jaw. In the emergency department, an ECG and cardiac enzymes were obtained. The cardiac monitor showed sinus tachycardia with occasional premature ventricular complexes. K.R. was treated with 2 L nasal oxygen, thrombolytic therapy, sublingual nitroglycerin, and IV morphine sulfate. When he was pain free, he was transferred to the cardiac unit for monitoring.Case-Study: Chronic Heart Failure