Week 4 ihuman 1st attempt

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School

Chamberlain College of Nursing *

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Course

578

Subject

Medicine

Date

Apr 3, 2024

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docx

Pages

26

Uploaded by Christinemmartin

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BP elevated – wide pulse pressure SpO2 – 091% SpCO – 1% Tachy – 120 Weight 1 month ago 190 – today 205 RR elevated Hands/Feet cool to touch Bibasilar b/l crackles 2+ pitting edema Hepatomegaly Neck – No visible scars, deformities/lesions Trachea midline and freely mobile Thyroid firm, an acceptable size for gender/age No nodules palpated JVP 12cm above sternal angle, positive hepatojugular reflex Lymphatics – No pathologically enlarged lymph nodes in the cervical, supraclavicular, axillary inguinal
Percuss A&P chest - Dullness to basilar percussion b/l
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Heart auscultation – S3
Dynamic auscultation – no significant change when standing, sitting, during Valsalva maneuver or with sustained handgrip
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Tests – ECG, BNP, Pro BNP?, BMP, CBC, LFT, TSH, UA, CXray -
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Diff Dx CHF – MNM Lung ca – MNM - alt Pna – MNM - alt ILD – MNM - alt Pulm embolism – MNM alt Viral cardiomyopathy – MNM alt Hypothyroidism – alt MNM hyperthyroidism – alt TX – Lifestyle mod, diuresis, pharm tx?, educate HF, medications, home care, okay outpatient or admitted?
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F/U information PLAN Diagnostic Tests Patient should have a Chest X-Ray related to his shortness of breath, an EKG related the S3 appreciated on auscultation, a TTE to assess the structure and flow of the heart. Patient should have a CMP, CBC, Lipid Panel, Iron studies, BNP, NT-proBNP, UA and TSH. These will help rule out other diff dx such as kidney failure, anemia, hypothyroidism. A stress test can also be helpful in diagnosis (Heidenreich et al., 2022). Pharmacologic Interventions -The patient should be started on Furosemide 20mg once daily for his elevated BP and fluid retention (Heidenreich et al., 2022). -There are also recommendations to start a patient on ACEi or ARB to inhibit the renin-angiotensin system. This can reduce morbidity/mortality in heart failure patients. Patient can be started on Lisinopril 5mg daily (Heidenreich et al., 2022). -Patient should continue taking Metoprolol as beta blockers help to reduce the risk of death in HF patients (Heidenreich et al., 2022). Non-Pharmacologic Interventions Patient should maintain healthy lifestyle habits such as regular BP monitoring, weight loss, healthy diet, and regular physical activity (Heidenreich et al., 2022). Suggested Consults/Referrals Cardiology - This patient should be referred to a cardiologist for continued management, especially if initial interventions do not improve patient's symptoms. Heart Failure should be managed by a multidisciplinary cardiovascular team to provide the most appropriate treatment. Dietitian/Nutritionist - This can be offered to the patient to provide education on healthy eating and weight loss. Client Education
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Patient should be educated on how to properly check BP at home, and how to take a consistent daily weight (upon waking, after first void) and reasons behind it. Patient should also be educated on weight loss options and how this will help his heart failure (Heidenreich et al., 2022). Patient should be educated on all medications, including potential side effects. For instance, Lisinopril may cause the patient to have a dry cough, which for some patients is intolerable. Patient should also be educated on the life-threatening side effect of angioedema, and that if the patient experiences any of these symptoms to immediately call 9-1-1 (Goyal et al., 2023). Follow up Patient should have labs drawn 2 weeks after starting new medications to ensure normal kidney function and electrolytes. The patient should come back following that lab draw for BP check and to see if diuretics have improved edema/SOB. If patient starts to experience chest pain, sudden inability to breath, rapid or irregular heart beat or sudden weakness/dizziness, the patient should report to the ER immediately (Heidenreich et al., 2022). References Goyal, A., Cusick, A.S. , & Thielemier, B. (2023). ACE inhibitors. In StatPearls. story, StatPearls Publishing. Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure. Journal of the American College of Cardiology, 79(17). https://doi.org/10.1016/j.jacc.2021.12.012
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