A 70 year old black American female who has the following preexisting conditions;
Hypertension (HTN): longterm
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Heart failure (CHF) : 2 months
Coronary artery disease (CAD) : longterm
Myocardial infarction (MI) : five years ago
Ejection (EF) of 55% : 2 months ago
Widow, Lives alone, independent ADL’s, Nonsmoker, Nondrinker
Aspirin (acetylsalicylic acid, ASA)
Clopidogrel bisulfate (Plavix)
Lisinopril (Prinivil, Zestril)
Potassium chloride (KCL)
70 year old woman originally from Alabama. She lives alone and is able to manage herself independently. She is active in her community and church. Diagnosed with heart failure 2 months age and is followed up at home with a visiting nurse every other week for to assist is managing her heart failure symptoms. She is being referred to the nurse practitioner for follow up of changes in her symptoms.
At the office the following subjective and objective data was supplied:
“I noticed my legs were getting a bit bigger and they are achy, too.”
She has gained 10 pounds over the last 5 days.
She gets short of breath when ambulating from one room to the other (approximately 20 feet) and must sit down to catch her breath.
Her oxygen saturation is 95% on room air. Bibasilar crackles are heard when auscultating her lung sounds.
She denies any chest, arm, or jaw pain or nausea.
She denies any back pain, stomach pain, confusion, dizziness, or a feeling faint.
She admits only to feeling a little more tired than usual.
Eats Southern Cooking when at home.
Vital signs :
T= 97.6 F (36.4C), BP 140/70, P 93, R 22.
complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide assay or BNP), troponin, creatine kinase (CPK), creatine kinase-MB (CKMB), and albumin. The APN also prescribes oral (PO) Furosemide and arranges an outpatient electrocardiogram (ECG, EKG), chest X-ray, and echocardiogram.
1. Which assessment findings during this visit are consistent with heart failure?
2. Why did the APN ask about back pain, stomach pain, confusion, dizziness or a feeling that she might faint?
3. Explain what the following terms indicate and include the normal values: cardiac output, stroke volume, afterload, preload, ejection fraction and central venous pressure. Is an ejection fraction of 55% significant. Provide rationale.
5. Discuss the body’s compensatory mechanisms during hear failure. Include an explanation of the Frank-Starling law in your discussion.
6. Heart failure can be classified as left or right ventricular failure, systolic versus diastolic, according to the New York Heart Association (NYHA) and using the ACC/AHA (American Heart Association) guidelines. Explain these four classification systems and the signs and symptoms that characterize each. Which Classification fits this patient?
7. Provide a rationale for why each of the following medications have been prescribed: Aspirin, Clopidogrel bisulfate (Plavix), Lisinopril(Prinivil/Zestril) , and Carvedilol (Coreg).
8. What information will each of the following tests provide: CBC, BMP, BNP, Troponin, CPK, CKMB, and albumin, EKG, CXR, and Echocardiogram