Reference no: EM133926748

Assignment: Nursing Case Study

Cardiovascular Case Study:

Rose Dior is a retired collegiate rowing coach. Recently, she has notice a decrease in stamina and presents to the emergency department (ED) complaining of progressive dyspnea on exertion and lower leg edema over the past 3 days. She states that she cannot even climb the stairs to her second-floor bedroom without gasping for air, much less being able to keep a good rowing form, which she had no problem doing last week. The ED nurse attaches her to the cardiac monitor and obtains a set of vital signs. Rose Dior is in sinus tachycardia at a rate of 104 beats per minute. Her blood pressure is 170/94 mm Hg and her respiratory rate is 28 breaths per minute and labored. Her oxygen saturation is 96%. She is placed on 2 liters oxygen by nasal cannula. The nurse inserts an intravenous catheter (saline lock) and obtains a brief history from the patient.

The interview indicates that Rose Dior is a 63-year-old female with a history of hypertension, pre-diabetes, and coronary artery disease. She had a myocardial infarction (MI) 3 years ago. She has never smoked, uses alcohol occasionally (less than once per week), and has no allergies. Her height is 65 inches and she weighs 150 pounds. Her medications include carvedilol 25 mg twice daily, lisinopril 40 mg daily, simvastatin 20 mg daily at bedtime, and aspirin 81 mg daily. She states she has been compliant with taking her medications. Her blood glucose levels are well controlled with diet and physical activity.

Emergency laboratory tests are ordered, including chemistry, complete blood count, B-Type natriuretic peptide (BNP), and cardiac enzymes. A 12-lead electrocardiogram is done and reveals sinus tachycardia with an old inferior MI. A cardiology consult is ordered.

Rose Dior's physical exam reveals rales/crackles halfway up her posterior lung fields bilaterally. Normal S1 and S2 heart sounds with a positive S3 heart sound are heard. Lower extremities have 1+ pitting edema bilaterally up to her mid lower extremities.

Her laboratory results are as follows:

Complete Blood Count:

Normal

Chemistry:

Blood urea nitrogen 20 mg/dL
Creatinine 1.0 mg/dL
Sodium 144 mEq/L
Potassium 4.0 mEq/L
Chloride 109 mEq/L
Carbon dioxide 33 mEq/L
Glucose 123 mg/dL
Magnesium 1.5 mEq/L
BNP 656 ng/L

Cardiac enzymes Negative

Based on Rose Dior's presenting complaints, her physical examination, and her lab results, she is diagnosed with heart failure. She is admitted to the critical care unit for medical and nursing interventions.

Questions for Consideration and Care Planning:

A. What medication would be used first to treat Rose Dior's overloaded fluid volume status?
B. Why is it important to monitor electrolytes when patients are receiving a diuretic?
C. What test would you expect to be ordered next to evaluate the patient's heart function?
D. What is considered a normal left ventricular ejection fraction (LVEF)? Get the instant assignment help.
E. List two important teaching points that nurses need to teach to patients with heart failure.