Question: Mr. Jones Has Had Hypertension For The Last 10 Years, And Was Diagnosed With Atrial Fib And Congestive Heart Failure 5 Years Ago. He Has Hyperlipidemia. He Had Been Smoking 1 Pack A Day For 20 Years, But Quit Smoking 2 Years Ago. He Is A Social Drinker Only. No Known Drug Allergies, Immunizations Current With Annual Flu Vaccine. He Lives With Wife. …

Mr. Jones has had hypertension for the last 10 years, and was diagnosed with atrial fib and congestive heart failure 5 years ago. He has hyperlipidemia. He had been smoking 1 pack a day for 20 years, but quit smoking 2 years ago. He is a social drinker only. No known drug allergies, immunizations current with annual flu vaccine. He lives with wife. Both retired 3 years ago. He worked as a school maintenance supervisor. Mr. Jones has three adult children who are very supportive of their parents Recent Medical History Mr. Jones presented to the emergency department two days ago with dyspnea, orthopnea, fatigue, a weight gain of 10 pounds, and ankle edema. His appetite is poor, he complains of slight nausea, no emesis. Patient has received IV Lasix twice daily and has diuresed. approximately 2 L (weight down 4 lbs). Last lung auscultation revealed fine rales in the bases bilaterally, no cough, and 2+ edema in lower extremities. Clinical Findings . Awake and alert • Expressing fatigue Expresses feeling lightheaded Provider’s Orders . Code Status: Full Code Cardio-pulmonary: Vital signs every 4 hour including SpO2 Oxygen per nasal cannula 2-4L titrated to maintain Spo: > 92% Activity: out of bed as tolerated Intake and Output every shift Daily am weight. Diet: 2 gm sodium, low cholesterol IV saline lock Medications: Lasix 80 mg IV BID. Altace 5 mg PO daily Coreg 3.125 mg PO BID with food (hold if Systolic blood pressure < 90) Amiodarone 200 mg PO daily K-Dur 40 mg PO BID with food Spironolactone 12 5 mg PO daily Coumadin 2.5 mg PO daily Labs: BNP, BMP, CBC Specials Echocardiogram, CXR, 12-lead ECG o 000 . . . . What is congestive heart failure? How is congestive heart failure treated? Medications? PCC: How did the patient describe his/her symptoms? T&C: Describe why you called for help. T&C: Was communication closed loop and clear? How do you know this? EBP: Describe how the plan of care was individualized based on patient values, clinical expertise, and evidence. EBP: Would you describe the care you provided as a “routine” approach? If so, is there new evidence to support an alternative approach to care? What is the current policy at your local institution? EBP: What is a reliable source for locating evidence reports and clinical practice guidelines? .