Help Case Study: Heart Failure Ms. Agnes
Help Case Study: Heart Failure Ms. Agnes is a 76-year-old female, presenting to the Emergency Department (ED) via ambulance for evaluation of shortness of breath. Reports symptoms began 4 days ago with gradually worsening SOB and fatigue. Experiences chest tightness with exertion but denies chest pain, also has a slight cough. Symptoms worsen with exertion and long conversations. Reports waking up during the night feeling like she could not catch her breath. Medical History: COPD, pulmonary emphysema, asthma, Type II Diabetes, HTN. Medications upon Admission: Albuterol sulfate 2 puffs by inhalation every 6 hours Atorvastatin 40 mg p.o. every day Hydrochlorothiazide 25 mg p.o. every day Losartan 100 mg p.o. every day 1. What initial nursing assessments are priority? 2. What diagnostic tests do you anticipate? Further assessment reveals patient has crackles bilaterally, is tachypneic, and bilateral pitting edema of lower extremities. VS: BP 90/74, HR 103, RR 22, SpO2 93% on 2L NC, Temp 98.1, Weight 163 lbs (patient reports this is an increase of about 12 pounds over the past month) 3. What are notable concerns with VS and why? 4. What if any is significant about the reported weight gain the past month? Physician orders the following: Administer furosemide 40 mg; pharmacy supply is 10 mg/mL in 20 mg vials Administer heparin 25,000 units in sodium chloride 0.45% 250 mL IV infusion; 12 units/kg/hr 5. What is the rationale for the physician orders of furosemide and heparin? 6. How many mL of furosemide will be given? 7. What is the rate of infusion for IV push furosemide? 8. What is the units/hr of heparin to be infused? 9. Which medication should be administered first and why? 10. Will this patient need hospital admission? If so, what unit or level of care would be expected?
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