Heart failure case study PDF

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Heart failure case study...

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Overview Heart failure (HF) is an abnormal clinical condition that involves inadequate pumping and/or filling of the heart. This results in the inability of the heart to provide sufficient blood to meet the oxygen needs of the tissues. HF is characterized by ventricular dysfunction, reduced exercise tolerance, diminished quality of life, and shortened life expectancy. Several factors predispose patients to the development of heart failure. Any factor that interferes with the normal mechanisms of cardiac output can lead to heart failure. Heart failure is classified according to pathology (systolic or diastolic), the part of the heart affected (right- or left-sided failure), the person's tolerance to physical activity (New York Heart Association Functional Classification), and the absence or presence of ventricular dysfunction along with the severity of symptoms (ACCF/AHA Stages of Heart Failure). Interprofessional care of patients with heart failure includes nonpharmacologic, pharmacologic, and nutritional therapies. Complications arising from heart failure include pleural effusion, dysrhythmias, left ventricular thrombus, hepatomegaly, and renal failure. Objectives 

Identify risk factors associated with heart failure.

The two biggest risk factors for heart failure are coronary artery disease and hypertension. Other risk factors include tobacco, obesity, high cholesterol, diabetes, and advanced age.

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Describe the pathophysiologic changes related to heart failure.

Heart failure can be divided between either systolic or diastolic heart failure. Systolic failure comes from inability of the heart to efficiently pump blood. This is caused by ineffective contracting, increased afterload, and mechanical abnormalities. The left ventricle can no longer create enough pressure to pump blood forward through the aorta. This leads to hypertrophy and dilation of the LV. this decrease in output is called ejection fraction, which will be the biggest sign of LV systolic failure. Diastolic failure is when the ventricle fails to relax and fill during diastole. EF in this type of heart failure will be normal, but with decreased filling, this leads to a decrease in stroke volume and cardiac output. The LV will still hypertrophy in this heart failure due to hypertension or other vascular diseases.

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Prioritize assessment of a patient exhibiting an exacerbation of heart failure.

Priority assessment for a patient with exacerbation of heart failure would be to ask if the patient is experiencing chest pain or heaviness. Next would be to get an EKG done to assess for cardiac dysrhythmias and possible correction with medication. Auscultation of heart sounds would need to be done to listen for murmurs and assessing jugular vein distention. Neuro

status would show increasing confusion, restlessness and decreased attention span. Increasing circulating blood is priority,

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Evaluate diagnostic tests used for patients with heart failure.

Diagnosing heart failure can be difficult as the signs and symptoms can be closely related to other disorders. The first thing to do is find out the underlying cause of the heart failure. An endomyocardial biopsy (EMB) will be used to differentiate between systolic and diastolic heart failure. Ejection fraction will also need to be measured using echocardiography, and nuclear imaging studies. Lab studies will be done that will look at BNP levels that indicate left ventricle heart failure. N-terminal prohormone will also be measured as this is usually very accurate in diagnosing heart failure.

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Discuss drug management appropriate for a patient with heart failure.

Various types of drugs will be used in combination to treat patients with HF. Diuretics can be used as volume overload is common with these types of patients. These drugs help to reduce sodium reabsorption to increase sodium and water loss. Vasodilators such as hydralazine or nitroprusside will also be used to reduce circulating blood volume. This will decrease afterload increasing the cardiac output, increased renal perfusion, decrease BP, and decrease preload. Morphine is another drug that can be used to decrease anxiety and pre/afterload. Anticoagulants can also be added to the drug regiment to prevent thromboembolism and is usually recommended for patients with a-fib or an ejection fraction of 20% or less. Antidysrhythmic will be used prophylactically for dysrhythmias.

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Appropriately delegate care of a patient with heart failure.

The RN will be doing assessments of heart failure and the signs to look out for. Also, any teaching that needs to be done will be done by the RN. Delegation of medication administration will be given to the LVN. The UAP can obtain vitals, help the patient reposition, and take the patient their food.

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Formulate a teaching plan for a patient with heart failure.

Teaching for a HF patient would include teaching about modifiable risks and health promotion. This can include reducing weight if the patient is obese, promoting exercise, cessation of tobacco use, and diet modifications that would reduce cholesterol. An important teaching would be adherence to medication regiment. There can be multiple medications being used to treat HF symptoms, so the patient needs to know when and why the medication is important for long term success of preventing/recovering from HF. Signs of worsening heart failure such as increasing edema, SOB, and weight need to be taught so the patient knows when to call the HCP. Lastly the patient will be taught the importance of the follow up appointments, so progress can be noted and reinforced teaching if needed can be done.

Case Study R.K. is a 68-year-old white woman with a history of type 2 diabetes, hypertension, hyperlipidemia, and coronary artery disease (CAD). She has had two myocardial infarctions (MIs) over the past several years. She smoked 2 packs of cigarettes for 30 years, quitting after her first MI 4 years ago. She has been overweight most of her life and has no regular exercise except for household duties. R.K.'s current drug regimen includes ezetimibe/simvastatin (Vytorin) 10/40 mg/day, indapamide 2.5 mg/day, and losartan (Cozaar) 50 mg bid. She has scheduled an appointment with the nurse practitioner at the local health care clinic....