Background: T.R. is a 73 year old
Background: T.R. is a 73 year old client was just admitted to the progressive cardiac care unit for an acute exacerbation of heart failure. T.R. was diagnosed with left and right systolic and diastolic heart failure six years ago. The client has a ACCF/AHA classification of D and NYHA classification of stage IV. The client’s co-morbidities include: HTN, DM, renal failure, asthma and GERD. TR. has had three admissions in the last 30 days. Shift Assessment: Temperature 98.6 F (oral), HR 120 bpm (apical), B/P 170-92 mmHg, RR 33 (labored), SPO2 89% on 2 L NC, Pain 7/10 in right upper quadrant, and 5/10 chest pain Skin: dusky with cyanotic lips and fingernails, Client appears restless and slightly confused, Heart: Heart sounds revealed S1, S2, S3, and S4, murmur auscultated at aortic valve, client has visible jugular venous distension, and +3 pitting edema in the lower extremities (knees to toes) Lungs: course crackles and wheezing heard in all lung fields, Client’s weight has increased 10 lbs since last admission 5 days ago. Current weight 420 lbs. Diagnostics this Admission: Chest X-ray: indicates pulmonary congestion, displaced apex of the heart, and cardiac enlargement Echocardiogram: Ejection fraction of 15% BNP 750 K+ 3.2 mEg/L Na+ 133 INR 2.3 Blood Glucose 220 telemetry: A-fib 120 bpm Medication Orders: Lisinopril 40 mg PO BID carvedilol 25 mg PO BID furosemide 40 mg IVP Q8H Warfarin 2 mg PO BID Insulin Lispro 0.5 unit/kg day insulin glargine 0.2 unit/kg day 1 time daily nitroglycerine 0.3 mg SL PRN Match the presenting manifestations to left sided or right sided heart failure. (Must get all correct to receive 1/2 point) Group of answer choices course crackles JVD 3+ pitting edema right upper quadrant pain Shortness of breath Question 2 How would the nurse assess for effectiveness of the furosemide in left sided heart failure? How would the nurse assess for effectiveness of furosemide in right sided heart failure? Question 3 What are the three priority side effect assessments associated with carvedilol? Question 4 What are the recommended interventions for Class IV Stage D? Is the client currently being prescribed the correct interventions? Question 5 Describe 1. purpose 2. one side effect 3. one client education for each medication: Dopamine Milrinone Digoxin Nesiritide associated with positive inotropes dopamine, dobutamine, milrinone and digoxin Question 6 Review each of the following lab values for this client and address the following for each: 1. is the value normal or abnormal? 2. If abnormal what is possible cause ? (response must be specific to this client) BNP K+ Na+ INR Question 7 Provide brief client education for each of the following self-management requirements: (0.5 point -must have all to receive credit) dietary fluids weights signs and symptoms Question 8 Two months later, TR is readmitted and it is determined that medication therapy has not been successful. What are the next treatment options?
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