Heart Failure 1st visit PDF

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Heart Failure Home Health Reasoning 1 of 2 FIRST Home Health Nurse Visit

Frank Smith, 75 years old

Primary Concept Perfusion Interrelated Concepts (In order of emphasis) • • • • NCLEX Client Need Categories

Clinical Judgment Patient Education Communication Collaboration Percentage of Items from Each Category/Subcategory

Safe and Effective Care Environment ✓ Management of Care ✓ Safety and Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity ✓ Basic Care and Comfort ✓ Pharmacological and Parenteral Therapies ✓ Reduction of Risk Potential ✓ Physiological Adaptation Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights reserved.

Covered in Case Study

17-23% 9-15% 6-12% 6-12%

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6-12% 12-18% 9-15% 11-17%

✓ ✓ ✓ ✓

✓ ✓

Initial Data to Review from Chart: Current Problem/Reason for Home Health Care: Frank Smith is a 75-year-old male who is 5 feet 10 inches tall (178 cm). His baseline weight is 255 lbs. (115.9 kg-36.6 BMI). He has a history of type II diabetes, myocardial infarction, hypertension and chronic systolic heart failure (ejection fraction 40%) secondary to coronary artery disease.

Summary of Inpatient Admission: Frank presented to the emergency department complaining of weakness, fatigue, decreased tolerance to activity, shortness of breath with exertion, weight gain of three pounds in 24 hours, and productive cough with blood-tinged sputum. Furosemide IV was administered to address fluid volume excess and 4500 mL fluid was removed. Before discharge, he is at his baseline weight. Review of medication and nutrition therapy was provided before discharge and he had no questions.

Re-Hospitalization Risk Assessment: This is Frank’s second inpatient admission in the last 30 days due to acute decompensated heart failure. He is discharged with a diagnosis of pulmonary edema and exacerbation of chronic systolic heart failure. A referral was ordered for home health care follow-up, and a registered nurse is scheduled to visit his home within 24 hours after discharge to assess patient, determine medication adherence, and his understanding of management of heart failure. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential)

RELEVANT Data from Current Problem: Baseline weight, DMII, MI, HTN, EF 40% 2-2 CAD

RELEVANT Data from Inpatient Admission: Weakness, SOB, weight gain, blood tinged sputum, diuretics, weight loss.

RELEVANT Data from Re-Hosp. Risk Assess: Second admission for same problem, pulmonary edema, RN follow up

Clinical Significance: This patient has a significant cardiac history and is at increased risk of having another MI. He is probably on several different medications that put him at risk for bleeding.

Clinical Significance: Patient was experiencing symptoms of pulmonary edema sencondary to heart failure. He recently experienced fluid imbalance. He hasn't been feeling well. Monitor blood sugar, respiratory status, and f/e balance- especially considering diuretic use.

Clinical Significance: This patient will be monitored after discharge. The patient will need cardiorespiratory assessment

Social History: Frank is a retired engineer whose wife died unexpectedly one year ago after fifty years of marriage. He has become less active since she died and rarely gets out of the house. Since his wife did most of the cooking, Frank mostly eats either soup out of a can or frozen meals that need to be heated up. He has three grown children and six grandchildren, but they all live out of state. What data from the social history are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential)

RELEVANT Data from Social History: Lives alone, wife died, high sodium diet

Clinical Significance: The patient could be depressed, high sodium diet may aggravate HF, he doesn't have family close to keep an eye on him or possibly help him with meals and medications. If he would have another MI and be unable to call 911 nobody would notice.

Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights reserved.

Lab Results: Prior to Discharge Cardiac Labs:

Prior to Discharge:

BNP (B-natriuretic Peptide) (...