T-Mobile 10:14 PM * 56%. Back Group A Detail Submission Grade Group A Due: Aug 4

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T-Mobile 10:14 PM * 56%. Back Group A Detail Submission Grade Group A Due: Aug 4, 2018 at 11:59 PM Group A Case Study Presentation Day 1 A 52 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 Dashboard Calendar ToDo Notifications Inbox

Explanation / Answer

1.Medical diagnosis is Congestive Heart Failure.Congestive heart failure is the inability of the heart to pump sufficient blood for the tissues and organs to meet their oxygen demand.

2. Diagnostic methods used in heart failure are:-

- Electrocardiogram

- Chest X ray

- Echocardiogram

- Lab studies will include serum electrolytes,BUN(blood urea nitrogen)creatinine,complete blood count, brain natriuretic peptide.

- Urine analysis

Cardiac stress test and catheterization.

Serum electrolytes ,BUN,creatinine,CBC are done to see whether there is a problem in liver function like decreased potassium , sodium,magnesium level which cause cardiac dysarthymias, fluid and electrolyte balance in the body.Disorder in kidney function will lead to fluid accumulation and decreased excretion of waste products and increase the workload on heart.

Echocardiogram will provide the picture view of the heart valves and chambers ,it will measure the ejection fraction means the percentage of blood pumped by the heart. It will provide us details of any valve stenosis, regurgitation.

Electrocardiogram is the graphical representation of the electrical activity of the heart. Any changes in the electrical activity due to diminished conductivity , electrolyte imbalance will affect the heart's efficiency. It will help in reaching to the actual cause.

Chest X-ray will provide information regarding the pulmonary function. It helps to find out any increase in heart size ,pleural effusion , pulmonary edema , etc which will compress heart and decrease the pumping ability.

Urine analysis will help in finding out kidney and liver disorders like stones , blood pressure , diabetes mellitus which ultimatelyl leadto heart disease.

Cardiac stress test compare the heart's circulationt when the person is in rest and when he is doing the cardiac trade mill test .It helps in finding out coronary artery diseases.,which might be the cause of heart failure.

Cardiac catheterization are the procedures done to find out any blocks in the heart . Coronary artery blocks cause decreased blood supply to heart ,hence ability to pump blood dimnishes.

3. The treatment plan will change according to the severity.

- Pharmacological treatment methods include :-

Oxygen therapy for shortness of breath.

Oral and IV fluid therphy according to patients input and output ratio.

IV medication to reduce edema like loop diuretics ,, vasodilator therapy,ACE inhibitors beta blockers, calcium channel blockers etc to reduce blood pressure. Cardiac glycosides to decrease the rate of contractions and to treat dysarthymias .

Anticoagulant therapy for atherosclerosis

Dobutamin infusion therapy to reduce peripheral resistance, increase cardiac output, increase urine output.

-Non pharmacological methods:-

Lifestyle modification include these:-

Decrease intake of sodium in diet.

Avoidance of excess fluid intake and alcohol.

Avoidance of smoking.

Weight reduction .

Regular exercise plan .

Nursing process :-

a. Assessment- Nurse assess that the patient is having difficulty in breathing ,auscultate lungs to find crackles and wheezes . Documents the respiratory rate and depth of respiration.

b. Diagnosis- Respiratory distress related to excess fluid due to heart failure as evidenced by crackles on auscultation of lung sounds , nocturnal dysnea,orthopnea, decreased saturation level.

c. Planning - To reduce the respiratory distress,to promote activity, maintaining the fluid electrolyte balance,reducing fatigue ,to reduce the anxiety , encouraging the patient to verbalise his or her feelings.

d. Implementation-providing semi Fowler's position to improve breathing, providing oxygen therapy according to the requirement ,administering loop diuretics to increase the urine output,strict maintenance of patients input /output chart . Providing patient low sodium diet to avoid excess fluid .

e. Evaluation -Nurse will evaluate the patient after the administration of interventions whether the goal is achieved or not ,in this diagnosis the decrease in respiratory distress is the outcome.

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