Heart Failure Case Study Discussion Paper
Heart Failure Patient Profile M.G. is a 77-year-old woman who saw her health care provider for dyspnea. She is now being admitted to the hospital for acute heart failure. She was diagnosed with heart failure six years ago. She is currently taking the following medications: • Furosemide (Lasix) 40 mg PO daily • Potassium chloride (K-tab) 20 mEq PO daily • Enalapril (Vasotec) 10 mg by mouth BID Subjective Data • Was taking furosemide (Lasix) at home but ran out two days ago and has not been able to refill her prescription • Complains of difficulty breathing; had to “sleep in the chair” last night • Heart Failure Case Study Discussion Paper
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Has some swelling in her feet that is worse than usual Objective Data Physical Examination • Temperature 98.4° F, pulse 92, respirations 24, blood pressure 144/86, oxygen saturation 89% on room air • Height 5’5”, weight 170 lb • Alert and oriented to person, place, and time • Fine crackles bilateral lower lobes • Shortness of breath with minimal exertion • S1 and S2 without murmur or extra heart sounds • Capillary refill sluggish in lower extremities, normal in upper extremities • 2+ pitting edema bilateral lower extremities Collaborative Care Admission orders include: • Oxygen 2 L per nasal cannula • Furosemide (Lasix) 40 mg intravenous BID • Enalapril (Vasotec) 10 mg by mouth BID • ECG now • Vital signs with pulse oximetry every four hours • 2-gram sodium diet • Accurate 24-hour intake and output (I/O) • Daily weight Discussion Questions 1. Describe a plan for implementing these orders. 2. Based on M.G.’s clinical manifestations, what type of heart failure do you suspect? 3. What assessment data will you use to determine the effectiveness of the physician’s orders? 4. What is the rationale for the oxygen, IV furosemide (Lasix), and enalapril (Vasotec)? 5. What are the priority nursing diagnoses for this patient? 6. What other orders might you anticipate for this patient? Heart Failure Case Study Discussion Paper