Heart Failure Case study Heart Failure Case study / Case Study of JoAnn Smith 72 years old Heart Failure
Gas Exchange
Patient
... [Show More] Education
Communicaction
Collaboration
Fluid and Electrolyte Balance
Clinical Judgment
UNFOLDING REASONING CASE STUDY ; STUDENT HEART FAILLURE
History of present problem :
Clinical Reasoning Begins…
1.
What is the primary problem that your patient is most likely presenting with? The primary problem that my patient is most likely presenting with is congestive heart failure.
2.
What is the underlying cause/pathophysiology of this primary problem?
The underlying cause of this primary problem is her ejection fraction of 15% due to cardiomyopathy caused by an myocardial infarction and atrial fibrillation.
3.
What body system(s) will you most thoroughly assess based on the primary/priority concern? I will thoroughly assess her cardiac function, respiratory function, and neurologic functions.
4.
What is the worst possible/most likely complication to anticipate? Most likely/worst complication to anticipate would be we over correct her too much and she becomes hypovolemic.
5.
What nursing assessments will identify this complication EARLY if it develops? BP gets too low, respirations become shallow and less than 10 per minute, she show signs of change of level of consciousness.
6.
What nursing interventions will you initiate if this complication develops? Stop infusing nitroglycerin first and foremost, increase oxygen if needed. Call HCP to see if I can give a med to increase blood pressure/decrease HR.
7.
What psychosocial needs will this patient and/or family likely have that will need to be addressed?
See if she wants to talk to a Chaplin or other spiritual leader about the unexpected loss
of her husband. See if she interested in talking to a psychiatrist about her depression
8.
How can the nurse address these psychosocial needs? Get referral for social worker for group therapy, try to contact a chaplin for her to talk to. Just being there and talking to her like a human being and not just a patient.
1.
Has the status improved or not as expected to this point? Her blood pressure has improved; she still requires a bunch of supplemental oxygen to, coarse crackles can still be heard upon auscultating her lungs. She only managed to produce 30 ml of urine in 4 hours even after receiving 40 ml of furosemide. Has not converted out of atrial fibrillation.
2.
Does your nursing priority or plan of care need to be modified in any way after this evaluation assessment? I would say yes. I would contact HCP to see if her dose of furosemide can be increased. See she needs an echocardiogram to see if her ejection fraction improved; check and see if there are clots forming due to a. fib.
3.
Based on your current evaluation, what are your nursing priorities and plan of care?
Now that her blood pressure has significantly improved I would divert most of my care with improving her breathing and oxygenation saturation. I would still monitor her blood pressure. See if there is a way to increase her urine output, watch for signs of PE and assess for increase swelling.
Education Priorities/Discharge Planning
1.
What will be the most important discharge/education priorities you will reinforce with the patient’s medical condition to prevent future readmission with the same [Show Less]