CARE OF THE PATIENT WITH CONGESTIVE HEART FAILURE Current complaint: Mes Patters
ID: 137806 • Letter: C
Question
CARE OF THE PATIENT WITH CONGESTIVE HEART FAILURE Current complaint: Mes Patterson is a 72-year-old Caucasian woman presents with shortness of breath, edema in hands&feet&feeling exhausted with activity. These feelings have become increasingty worse Past history HITN, smoked 1 ppd of cigaretes for 40 yeark qut 5 years age, obesity.3-pillow orthopnea and noctuna. She has had diffioulty linding transportation to the local clinic&paying for her medications She stopped taking all medications 2 weeks ago Medications. Digatin 0.25ng PO daly. Enalaprg 5 mg PO BD Luis 20 mg PO daly Family history: Father HTN &died of a heart attack at age 59 Mother Type Il diabetes, muliple alergies & Psychosocial history: Widowed, Iiving alone in an upstairs apartment alone She has a cat named Ruffies. She survives on her Social Security checks. She has one daughter lving in another city. She considers her resources to include her daughter, her eidey neighbor, and har church She is very concemed that her daughter should go home and not miss work She becomes searfu when taikung about her cat and who will take care of her. She has requessed you noaity her pastor to come and pray with her She mentions several times that she does not want to be a burden to people Objective findings: An elderly woman weighing 178 ib. 57 Alet& orented to person, place & time vs.HR-128 RR. 30 BP. 1w104 L.and 194se R ,Sa iesonRA Respiratory is labored using accessory muscles. She becomes more tachypnelc with any exerion Ligs & nalbeds dusky. Heart tones S1 S2 53 (summation galopl. ExiG monitor seveals tachycardia and signs of a previous myocardial infarction Breath sounds reveal crackles anterior and posteriorly in mid and lower lobes bilateraly that do not clear with coughing She reports leeling nestiless& short of breath. Her sin is cool and daphoretic and her hands & feet aro ede- wts. pting ederna to "ilsts Labs and Diagnostics: Na 141 mEoL, CI95 mEt, K30mEqt Glucose 140 mgldl, Blood urea nitrogen (BUN) 40 mgld, Senum creatinine 2.1 mgil BNP (Brain Naturetic Peptide) 900 pglm Urinalysis reveals 2+ proteinuria. Chest x-ay reveals bbaslar ats and cardiomegaly with right and left ventricular hypertiophy. Echocardiogram reveals an EF Oeton txton) of 20% Admitting Orders 2 gr sodium det ath 2Lday fluid restriction Daly weights Lasix (Furosemid) 80mg IV Now and BID Potassium 40mEq PO BID Vasotec (Enalapril) 5mg PO daly Orygen to keep sats >90% 12-iead EKG & basic metabolic panel daily Content Questions: 1. What clinical manifestations of heart tailure is Mrs P ehibting? What is the signficance of these mandestatons in the heart failure patient 2. What are the significant lab and diagnostic results for Mrs. P. in nelation to her CHF? Are there any other labs or d agnestics t that may be ordered?Explanation / Answer
1. a) What clinical manifestation of heart failure is Mrs P exhibiting?
b.)What is the significance of these manifestations in heart failure patient?
a. Clinical Manifestations
b. Significance of these manifestations in heart failure patient
2. a. What are the significant lab and diagnostic results for Mrs P, in relation to her CHF?
b. Are there any other lab or diagnostics that may be ordered?
a. Significant lab test done for Mrs P:
b. Other lab tests that can be done:
3. Explain the rationale for each of the admitting orders?
4. a. How can we differentiate right and left sided heart failure?
b. What type of heart failure you feel is Mrs P is presenting with?
c. And Why?
a. Difference between right and left sided heart failure:
Right side of the heart brings circulated blood from the body and sends it to the lungs to get oxygen. When the left heart failure takes place, the right heart has to work harder to compensate. Continuous effort and pressure on right heart lead to its failure.
Left side of the heart brings oxygen rich blood from the lungs through the atrium to the ventricles and then into the body.When the left side of the heart cannot pump enough blood to the body ,it leads to left sided heart failure.
b. Mrs Patterson is exhibiting Left Heart Failure.
c. Beacuse she has shortness of breath which is the common symptom of left sided heart failure.
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