PRESENTATION Introduction Include an introduction that outlines the overall structure

The following scenario describes the case of Mrs Gina Goddard who had an unplanned medication-related hospital readmission within 72 hours of discharge post-surgical repair of a fractured Left femur. Mrs Goddard is a 78-year-old woman who is returning home following an open reduction and internal fixation (ORIF) for a left hip fracture sustained after a fall at home. Mrs Goddard has heart failure with reduced ejection fraction (HRrEF), diagnosed 12 months ago, post experiencing a ‘silent’ anterior myocardial infarction. She has a history of hypertension and hypercholesterolemia. Prior to this latest hospital admission, Mrs Goddard was living in her own home independently, managing her own activities of daily living including medications. She is mobilising with a frame and has required regular pain relief post operatively. Mrs Goddard’s discharge medications were dispensed in blister pack and did not include any analgesia. She was advised by the discharge nurse to visit the community pharmacy for over the counter (OTC) medications (e.g., nonsteroidal anti-inflammatory drugs) and to take Ibuprofen 400mg TDS. Her blister pack contained the following morning medications: Enalapril 20mg daily Bisoprolol 10mg daily Spironolactone 25mg daily Furosemide 40mg daily Atorvastatin 40mg daily Two days post discharge Mrs Goddard phoned her daughter because she was feeling breathless and was having difficulty using the walking frame because her ankles were very swollen. On further questioning from her daughter, Mrs Goddard denied pain and said she had been managing this well with the new pain killers that the nurse recommended for her on discharge. She did admit to feeling increasingly breathless over the weekend and needed to sleep in the recliner chair at night. She had not felt safe standing on the scale, so she had not weighed herself since discharge from the hospital. Mrs Goddard did have an appointment with her General Practitioner for Wednesday the following week, and an outpatient appointment in two weeks with the orthopaedic surgeon. Being a Sunday, Mrs Goddard’s daughter decided to take her into the emergency department for review. On admission to the emergency department, her clinical observations were documented as: BP 190/110 HR 120 RR 28 SpO2 96% with 6L oxygen via Hudson mask AE: diverse crackles auscultated bilateral lung fields Pitting oedema bilateral legs A peripheral intravenous cannula was inserted, and bloods were taken. She was prescribed intravenous Furosemide 80mg which was administered with good effect. Mrs Goddard was admitted with exacerbation of heart failure for investigation. Explain the pathophysiology and clinical manifestations of heart failure with reduced ejection fraction (HFrEF) as experienced by Mrs Goddard. Support your explanation with specific clinical information from the clinical scenario, Australian clinical guidelines, and evidenced-based literature.

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