Matt is a 70 year old retire

Matt is a 70 year old retire man. He has a medical history of Heart Failure. This developed after he experienced a two myocardial infarctions 8 years ago. Both ventricles were affected. Previous chest radiography showed left ventricular hypertrophy. The death of his wife 2 years ago has led to Matt experiencing several episodes of depression which has been exacerbated by his sons both moving to Western Australia for work. The loneliness and sadness makes it difficult for him to be concordant with his Heart Failure management and sustain the necessary lifestyle adjustments required to prevent exacerbations. This has resulted in several admissions to hospital for management and review of his Heart Failure. For this current admission, Matt was referred to hospital by his Nurse Practitioner, after recently rapidly gaining weight (currently 110kg), since his previous visit. The time now is 0800 and nurse have just come on for morning shift. Matt has been on the ward for only two hours after spending approximately 12 hours in emergency waiting for a bed to become available. Matt appears slightly disoriented. He tells nurse that he has spent the night in the recliner chair beside the bed, sitting upright because ‘this is the only way I can get my breath’. He tells nurse he feels terribly tired. Nurse observe that the 1 litre water jug that he has been drinking from, since coming to the ward, is nearly empty. Respiratory assessment Bibasilar posterior crackles Reduced breath sounds in the bases of both lungs Increased work of breathing Patient producing pink-tinged frothy sputum Cardiac assessment ECG: indicative of atrial fibrillation Skin is cool and clammy Vital Signs RR: 28 bpm Sp02: 94% on 2lt via nasal prongs BP: 105/82 mmHg HR: 122bpm Temp: 36.5oC Other information BGL within normal range GCS 14 – Eye opening – 4; Verbal response – 4; Best motor response – 6 Fluid status assessment Peripheral pulses difficult to palpate Presence of pitting oedema bilaterally Capillary refill – 5 seconds Raised JVP Output since midnight: 150ml Abdominal assessment Abdomen soft and non-tender. Bowel sounds present. 1. Explain the pathophysiological mechanisms which have resulted in Rupinder preferring to sleep in the recliner chair beside the bed. Identify any other data which supports your explanation.

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