Prince Georges Community College Nursing Assessments & Heart Failure Case Study

Heart failure case study

Question 1

Mrs. G is an 83 y/o female admitted with worsening heart failure. She has experienced increasing fatigue and “gets winded just walking out to the mailbox to get her mail.” She also is crying because her rings do not fit and she is waking up at night with trouble breathing. Sometime she forgets to take her medicine and she has had a poor appetite, and sometimes just eats a little toast and milk for dinner.

Admission labs are

• Sodium 138
• Chloride 102
• Potassium 2.9
• Glucose 93

She has an EKG that shows Normal Sinus Rhythm at 72

The doctor has reordered her home meds listed below

• Digoxin 0.25 mg po every morning
• Lasix 40 mg po every morning
• Metoprolol XL 25 mg po daily

The nurse assesses the patient:

• Dyspnea with exertion and needs HOB elevated to be able to breath while in the bed.
• Has 2 plus pitting edema in feet, ankles, and lower legs
• Says not eating because feels full all the time
• VS T 97.7, Apical heart rate is 64, RR is 22, Pulse Oximetry is 92% on room air.

The nurse is going to call the doctor. Review all of the above information and identify 3 additional assessments the nurse will want to perform before calling the doctor and give the rationale for each. (This is for 3 points, so make sure to include enough information to justify 3 points)

*citations and references

Question 2

Identify a priority patient problem (you are not required to write a nursing diagnosis) and at least 3 interventions (that address that priority problem) the nurse should institute at this time This patient problem should discuss a potentially serious physiological problem for the patient based on the above assessment and the nursing interventions must be specific to the problem. Keep in mind this case study is about heart failure, so use your book to look at what the authors of the textbook see as priorities in heart failure.

*citations and references

Question 3

The nurse is concerned about the lab work and the current medication list. You need to explain why the nurse is concerned.

Question is worth a total of 6 points

How and why is each prescribed medication being used in the treatment of heart failure. (how do they work and why are they being given for heart failure) 1 point each

• Digoxin
• Metoprolol
• Lasix

Explain which medication the nurse is concerned about giving and why (1 point).

Explain what lab work is concerning and what the nurse is going to ask for from the doctor (1 point).

What drug class might have been used in place/instead of digoxin and why would that drug be chosen (1 point)?

You must explain why each drug listed is being used specifically for heart failure–not a generic answer, but why are they being used here and how do they work.

For the last question, what could be the patient be taking instead of digoxin, long term. Do NOT put an IV medication, this is not what the patient will go home with. Basically, do you know what medication is recommended for the treatment of heart failure.

*citations and references