Heart Failure Case Study (45 min)
Mr. Jones, a 69-year old male, presents to the Emergency Department (ED) after visiting his primary physician complaining of general fatigue for 4 days, shortness of breath, and abdominal discomfort. Mr. Jones’s medical history includes hypertension and coronary artery disease. He had a previous 90% LAD blockage and 50% RCA blockage with stent placements in both.
Upon further assessment, the patient has crackles bilaterally and tachycardia. A chest X-ray shows cardiomegaly and bilateral pulmonary edema. An ECG revealed atrial fibrillation. His vital signs were as follows:
BP 150/72 mmHg Urine Yellow and Cloudy
HR 102-123 bpm and irregular BUN 17 mg/dL
RR 24-32 bpm Cr 1.2 mg/dL
Temp 37.3°C H/H 11.8 g/dL / 36.2%
Ht 175 cm LDH 705 U/L
Wt 79 kg ** BNP 843 pg/mL
Mr. Jones was admitted to the cardiac telemetry unit.
Mr. Jones states that this weight is approximately 3 kg more than it was 3 days ago.
About three hours after admission to the telemetry unit, Mr. Jones’s skin becomes cool and clammy. His respirations are labored and he is complaining of abdominal pain. Upon physical examination, Mr. Jones is diaphoretic and gasping for air, with jugular venous distension, bilateral crackles, and an expiratory wheeze. His SpO2 is 88% on room air and it was noted that his urine output had been approximately 20 mL/hr since admission. His BP is 190/100 mmHg, HR 130 bpm and irregular, RR 43 bpm.
Mr. Jones was transferred to the CCU for hemodynamic monitoring and aggressive therapy. His Central Venous Pressure (CVP) was found to be 19 mmHg, Cardiac Output was 4.5 L/min, Cardiac Index was 2.3 L/min/m2. He has been placed in high-fowler’s position, and his SpO2 is now 96% on 4L nasal cannula. Mr. Jones received Furosemide 80 mg IV and Digoxin 0.5 mg IV.
Melander, S. (2004). Case studies in critical care nursing: A guide for application and review, 3rd ed. Philadelphia, PA: Saunders Elsevier.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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