Cardiovascular Dysfunction

Cardiovascular Dysfunction

Mrs. Yates is a 70-year-old woman with a history of hypertension (diagnosed 8 years ago), coronary artery disease (diagnosed 8 years ago), myocardial infarction (MI) (occurring 5 years ago) and was diagnosed last year with heart failure. She is a widow, lives alone, is able to care for herself independently and is a nonsmoker. She reports that in the past 6 months, she has been becoming increasingly short of breath over shorter and shorter distances and now rarely leaves the house.
Mrs. Yates presented to the Emergency Department yesterday and was subsequently admitted to the medical ward where you are currently undertaking your clinical placement. On admission, the medical officer has noted the following assessment findings:
Physical Assessment:
• Respiratory distress – increased use of accessory muscles
• Respiration rate 36 breaths/minute
• SpO2 84% on Room Air
• Moist fine crackles in both lungs
• Heart murmur
• Blood pressure 90/60mmHg
• Heart Rate 125 beats/minute
• Electrocardiogram (ECG) : sinus tachycardia
• Cyanotic lips and extremities
• Skin cool and diaphoretic
• 4+ pitting oedema in lower extremities
• Temp 36.4oC ?Diagnostic studies
• Chest X-ray: Cardiomegaly with Right & Left ventricular hypertrophy. Fluid in lower lung fields
• Echocardiogram: Shows left ventricular ejection fraction 25%
Medical Officer’s orders:
• Chest physio/spirometry
• Digoxin – 0.25mg orally daily
• Frusemide – 40 mg IV BD
• KCL – 40mmol/L orally BD
• Enalapril – 5mg orally daily
• O2 6 L/min
• Low sodium diet
• Daily weighs
• Electrocardiogram (ECG) if reports chest pain
• 1500mL fluid restriction.
Critical Thinking Questions:
1- Explain the pathophysiology of heart failure and relate this to Mrs Yates.
2- Discuss and explain which assessment findings and diagnostic studies are consistent with heart failure.
3- Explain the rationale for each of the orders from the medical officer for Mrs. Yates, and include any nursing precautions that need to be considered.
4- Identify and discuss appropriate nursing interventions for Mrs. Yates that you will need to consider when writing her plan of care. List and discuss in order of immediate priority.
The outline that you must follow it:
soquestion one….what is heart failure? What causes it? Here you need to go into detail in terms of what happens to the heart, lungs, kidneys, rest of body. Question two….you need to look at the all the information you have been given and talk about how each is related to failure, based on the pathophysiology. Question one and two are a bit overlapping and it might be difficult to split them. You may find yourself repeating yourself a bit. Question three…..Then you need to look at all the recommendations and tell us why they will work. For example, salt and fluid restrictions. Why do we do that? And all the others listed there. There is plenty of information for you to work with. Then question four, how do you care for this person? What is important? Looking at things like elevating legs, exercise tolerance, fluid balance charts, diet, education, daily weight recording, encouraging physio etc. Just go through it step by step and it should make sense. Underline your key words. Do a little introduction, then set it out with those four questions as subheadings.

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