Case Study

Review all of the data in the following case study and answer the 5 questions below with 3 APA resources to support your work:

A 60-year-old client presents to the ED with severe onset shortness of breath, fatigue, and recent weight gain of 5kg. The client reports difficulty sleeping. He states, “I feel like I am drowning.” He reports using multiple pillows to improve this feeling without relief. This is the client’s second hospital admission this year for a similar complaint. His past medical history is significant for heart failure, a 20-year pack history of smoking, COPD, coronary artery disease, myocardial infarction, hypertension, hyperlipidemia, diabetes mellitus, and obesity. Past surgical history is significant for cardiac catheterization with stent placement. The client’s family reports he is not adherent to his medication regimen. He likes to eat fast foods and frozen dinners for most of his meals a week. He does not engage in exercise and lives a sedentary lifestyle.

Medication list includes:

1. Lasix 20 mg by mouth twice daily

2. Metformin 500 mg by mouth twice daily

3. Nebivolol 5 mg by mouth daily

4. Aspirin 81 mg by mouth daily

5. Rosuvastatin 40 mg by mouth daily

6. Lisinopril 20 mg by mouth daily

7. Fluticasone-vilanterol 100-25 mg inhaled daily

8. Albuterol-ipratropium inhaled every 4 hours as needed

9. Digoxin 60 mg PO daily

Physical Exam:

Initial physical exam reveals temperature 98.4F, heart rate 128/min, respiratory rate 28, BP 180/95, Height 160 cm, Weight 100 kg, BMI 39.1, oxygen saturation 90% on room air.

Alert and oriented x3, anxious, PERRLA, Cranial nerves 1-12 intact, Cardiac assessment reveals S1, S2, and S3 heart sounds, bilaterally pitting edema +2. Auscultation of the lungs revealed bibasilar pulmonary rales. There use of accessory muscles, nasal flaring, and severe shortness of breath. The abdomen is distended and non-tender, there is positive hepatojugular reflux, JVD >4cm. All other assessment findings were normal.

Diagnostics

EKG and chest x-ray revealed cardiomegaly, vascular engorgement, and mild interstitial edema.

Labs: Na 128 mEq/L, K 5.2 mEq/L, BUN 82 g/dL, Crt 1.8 mg/dL, trop I 0.1 ng/mL , BNP 1300 pg/mL, Glu 140 g/dL.

Answer the following 5 questions. Use APA at least 3 references to support your work, you can use the course text as one of your references. The references should be scholarly resources.

1. What are priority NANDA nursing diagnosis and interventions with rationales from evidence based literature for this client? (List at 3 diagnosis with 2 interventions per diagnosis).

Nursing Diagnosis

a. Intervention with rationale

b. Intervention with rationale

Nursing Diagnosis

a. Intervention with rationale

b. Intervention with rationale

2. List at least 4 signs and symptoms of heart failure:

a. Right sided heart failure

b. Left sided heart failure

3. From the case study identify heart failure symptoms in this client including history, diagnostics, and physical exam findings.

4. Provide the rationale for each of the following therapies for heart failure clients. Use APA references to support your work.

Oxygen administration:

Diuretics:

Inotropic drug therapy:

Vasodilator drug therapy:

Fluid restriction:

Sodium restriction:

5. What should a nurse include when planning discharge teaching for a client with heart failure? How can the nurse prevent rehospitalization in this client?