This case requires the nurse to recognize the symptoms of heartfailure and collaborate with the primary care provider to initiatetreatment. The pathophysiology of heart failure is reviewed.Several heart failure classification systems are defined.Rationales for prescribed diagnostic tests and medications areprovided. The nurse must consider the impact of the client’s dieton the exacerbation of symptoms and provide teaching. Nursingdiagnoses are prioritized to guide care.
Jeraldine Yates is a 70-year-old woman originally from Alabama.She lives alone and is able to manage herself independently. She isactive in her community and church. Mrs. Yates was admitted to thehospital two months ago with heart failure. Since her discharge, avisiting nurse visits every other week to assess for symptoms ofheart failure and see that Mrs. Yates is continuing to manage wellon her own.
Case Study The visiting nurse stops in to see Mrs. Yates today.The nurse immediately notices that Mrs. Yates’s legs are veryswollen. Mrs. Yates states, “I noticed they were getting a bitbigger. They are achy, too.” The nurse asks Mrs. Yates if she hasbeen weighing herself daily to which Mrs. Yates replies, “I got onthat scale the last time you were here, remember?” The nurse weighsMrs. Yates and she has gained 10 pounds. Additional assessmentfindings indicate that Mrs. Yates gets short of breath whenambulating from one room to the other (approximately 20 feet) andmust sit down to catch her breath. Her oxygen saturation is 95% onroom air. Bibasilar crackles are heard when auscultating her lungsounds. The nurse asks Mrs. Yates if she is currently or has in thepast few days experienced any chest, arm, or jaw pain or becomenauseous or sweaty. Mrs. Yates states, “No, I didn’t have any ofthat. I would know another heart attack. I didn’t have one ofthose.” The nurse asks about any back pain, stomach pain,confusion, dizziness, or a feeling that Mrs. Yates might faint.Mrs. Yates denies these symptoms stating, “No. None of that. Just alittle more tired than usual lately.” Her vital signs aretemperature 97.6ºF (36.4ºC), blood pressure 140/70, pulse 93, andrespirations 22. The nurse reviews Mrs. Yates’s list of currentmedications. Mrs. Yates is taking aspirin, clopidogrel bisulfate,lisinopril, and carvedilol. The nurse calls the health careprovider who asks the nurse to draw blood for a complete bloodcount (CBC), basic metabolic panel (BMP), brain natriuretic peptide(B-type natriuretic peptide assay or BNP), troponin, creatinekinase (CPK), creatine kinase-MB (CKMB), and albumin. The healthcare provider also prescribes oral (PO) furosemide and asks thenurse to arrange an outpatient electrocardiogram (ECG, EKG), chestX-ray, and echocardiogram
- Which assessment findings during the nurse’s visit areconsistent with heart failure?
- Why did the visiting nurse ask Mrs. Yates about back pain,stomach pain, confusion,
dizziness,or a feeling that she might faint?
- Discuss anything else the nurse should assess
- Heart failure can be classified as a left or right ventricularfailure. Describe each,
includesigns and symptoms.
- What information will each of the following blood testsprovide: CBC, BMP, BNP, troponin, CPK, CK-MB, and albumin?
- During the dietary teaching, the nurse asks Mrs. Yates todescribe a typical day of meals and snacks. Mrs. Yates lists coffeewith whole milk, eggs and sausage for breakfast, a sandwich or soupfor lunch, fried chicken with vegetables for dinner, and fruit,pretzels, or rice pudding for snacks. Which of these foods will thenurse instruct Mrs. Yates to limit and are there alternatives thatthe nurse can suggest?
- Prioritize two nursing diagnoses that the visiting nurse shouldconsider for the recent events regarding Mrs. Yates’s care.
