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Case Study 1: Heart Failure with Atrial Fibrillation

Meet the Patient: Jonathan Stevens

Sixty-three-year-old Jonathan Stevens visits the healthcare clinic complaining of increasing fatigue and difficulty breathing. Physical assessment findings include a rapid, irregular heart rate of 138 beats/min, BP of 140/86 mm Hg, and a respiratory rate of 28 breaths/min. His breath sounds are clear with fine crackles in the bases bilaterally. He has positive jugular vein distention (JDV) bilaterally and 1+ pitting edema of his ankles bilaterally. His initial medical diagnosis is heart failure (HF). Jonathan is immediately admitted to the acute care facility for further evaluation and treatment.

Risk factors

Heart failure occurs most commonly in clients over the age of 60 and occurs more commonly in males than females.

 

Question 1:  In addition to these two risk factors, what other risk factors will provide the nurse with the best data for the heart?

Clinical Manifestations 

 

Question 2: Name one assessment finding that would indicate that Jonathan is experiencing right-sided heart failure? 

Cardiac Dysrhythmias

Left-sided heart failure results in pulmonary fluid overload, and right-sided heart failure results in peripheral fluid overload. Left-sided heart failure usually occurs first and can trigger right-sided heart failure. 

Upon admission to the Cardiac Nursing Unit, Jonathan’s dyspnea continues. He reports fatigue but denies chest pain. The nurse places Jonathan on oxygen via a nasal cannula at 3L/min and a cardiac telemetry monitor. The ECG recording shows no discernible P waves, and a rapid, irregular ventricular response (QRS complexes). This corresponds with Jonathan’s pulse rate, which is 136 and irregular. 

 

Question 3: What cardiac dysrhythmia is Jonathan most likely experiencing? 

Question 4: Based on Jonathan’s cardiac dysrhythmia, what would the nurse implement first? 

 

Diagnostic Studies

Jonathan is scheduled for a chest-x-ray and 12 lead electrocardiograph (ECG). Additional diagnostic studies that may be performed include echocardiography and pulmonary artery catheterization. 

 

Question 5: Name the diagnostic test that is used to measure the pressure within the right atrium? 

 

Medication Administration 

The HCP prescribes the following medications for Jonathan: 

Digoxin (Lanoxin) 0. 125 mg IV every 6 hours x 4 doses, then 0.25 mg orally, daily
Furosemide (Lasix) 40 mg IV push, daily. 
Captopril (Capoten) 12.5 mg orally, three times a day
Docusate sodium (Colace) 100 mg orally, twice a day. 
Carvedilol (Coreg) 3.125 mg orally, twice a day. 
Warfarin (Coumadin) 5 mg orally, daily. 

Question 6: The nurse prepares a dose of digoxin )Lanoxin) 0.125 mg via IV push. The medication is supplied as 0.25 mg in 2 mL. How many mL should the nurse prepare to give? (Enter numeric value only. If rounding is necessary, round to the whole number). 

 

Question 7: What assessment is the most important prior to the administration of captopril (Capoten)?

 

Question 8: What is the expected outcome of digoxin (Lanoxin) therapy? 

Nursing Diagnoses and Interventions 

 

Question 9: List one priority nursing diagnosis to be included in the plan of care. 

 

Question 10: List one intervention that should be implemented based on the diagnosis of activity intolerance. 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 128

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