CASE STUDY – HEART FAILURE Donald Bergman Patient Assignment D.B. is a 67-year-old male who was admitted to the telemetry unit 1 day ago for med ical
... [Show More] management with a diagnosis of chronic heart failure (HF). D.B. has a 20-year history of hypertension and had an MI 6 years ago. He began having fatigue, tachycardia, and dependent bilateral lower extremity edema about 18 months ago, and was diagnosed with right ventricular HF. He was already taking enalapril for hypertension and was prescribed furosemide, potassium, and digoxin after his HF diagnosis. D.B.’s symptoms have worsened over the last month. Upon admission 1 day ago at 0800 VS: T 36.4° C (97.5° F), BP 156/98, P 126 and regular, R 36 and labored. O2 saturation 88% on RA. He had 3+ pitting edema in his feet and ankles, dyspnea, tachycardia, JVD, and crackles bilaterally in his lungs. He stated that he has been unable to “get enough air,” has been sleeping in the recliner, and has gained 5.5 kg (12 lb) in the past month. Admission weight 100 kg (220 lb), height 177.8 cm (70 in). He is a full code....1. What signs and symptoms did D.B. have 18 months ago when he was diagnosed with right ventricular
HF?
● He began having fatigue, tachycardia, and dependent bilateral lower extremity edema 3+.
2. What are some other signs and symptoms of right HF?
● (Symptoms are often nonspecific and similar to Left
Sided HF, but are often more severe)
● SOB during exercise or when lying flat(orthopnea),
paroxysmal nocturnal dyspnea (PND) (which is a fancy
word for waking up at night due to shortness of breath).
Usually with patients with biventricular HF
● Chest discomfort (resembles angina)
● Abdominal distention
● Anorexia
● Early satiety (feeling full faster), due to gut edema
● JVD
● Kussmaul breathing
● Cachectic (weakness and wasting of the body)
● Ascites and hepatomegaly
● Weight gain
● Pitting edema in lower extremities
3. What do his current signs and symptoms (3+ pitting edema in his feet and ankles, 5.5 kg (12 lb) weight
gain, dyspnea, tachycardia, JVD, orthopnea, and crackles bilaterally in his lungs) indicate?... [Show Less]