Heart Failure Case StudyJames is a 70-year-old male brought to theemergency department (ED) by ambulancewith complaints of shortness of breath. Thepatient's medical record shows a past history ofhypertension, diabetes, MI X 2, congestiveheart failure (CHF), and chronic renalinsufficiency. Upon assessment, James haslabored breathing at 36 breaths/min andtachycardia at 112 beats/min. His pulseoximetry is 90% on 40% oxygen via a facemask. Crackles are heard throughout his lungs.1. List potential causes and risk factors for hiscondition.2. Identify the typical symptoms of left-sidedheart failure vs. right-sided heart failure withan "L" or an "R" or "B" for both.CoughBlood-tinged sputumTachycardiaFatigueNocturnal polyuriaExertional dyspneaPeripheral edemaCrackles or wheezesJugular venous distensionAscites and GI distressOrthopneaCyanosisParoxysmal nocturnal dyspneaThe physician orders a chest x-ray, ECG,arterial blood gases (ABGS), and lab work to bedone. After an IV is inserted, the nurseadministers furosemide 40 mg IV push.3. Which lab test is a key diagnostic indicator ofheart failure?4. Arterial blood gas (ABG) results: pH 7.47, pO282, PCO2 30, HCO3 24. Evaluate the ABGabove and explain why this is occurring.James remains short of breath at rest, so he ismoved to the intensive care unit (ICU). An EKGis done, which shows an ejection fraction of40%. The physician orders James to be startedon a dobutamine drip and given an additional20 mg of IV furosemide.5. Order: Begin a dobutamine drip at 5mcg/kg/min. James weighs 214 pounds.Available: The dobutamine is supplied as 500mg in 250 mL of D5W.Calculate how fast to run the dobutamine inmL/hr:6. Match the medication used to treat heartfailure in Column A to its effect in Column B.Column AColumn BA.BenazeprilReducesadverseeffects fromconstantstimulation ofthesympatheticnervoussystem (SNS)B. FurosemideCatecholamine that increases cardiaccontractilityC. DigoxinDiuretic that removes excess extracellularfluidD. MetoprololPhosphodiesterase inhibitor that promotesvasodilationЕ.Dobutamine-_Angiotensin convertingenzyme (ACE)inhibitor thatpromotesvasodilationand diuresisF.MilrinoneCardiacglycoside thatincreases theforce ofmyocardialcontractionand slowsconductionthrough theatrioventricular (AV) nodeJames continues to improve and is moved to amedical floor after spending 2 days in the ICU.He is being prepared for discharge within thenext 1 to 3 days.7. The nurse educating James on hismedications for discharge determines that heneeds further instruction about his diureticwhen he states:A. "I can holdon taking myLasix on daysthat I amtraveling."B. "I shouldweigh myselfevery day atthe sametime."C. “I shouldtake my Lasixearly in theday so I amnot up allnight."D. "I need tocall the doctorif my legs startswelling morethan normal."8. Since James will be discharged on digoxin,the nurse needs to discuss which of thefollowing signs of digoxin toxicity? Select allthat apply.A. FatigueB. nausea,vomitingC. Erraticheart beatD. Changes invision9. What key discharge teaching points arenecessary to reduce rehospitalization and helpthe patient manage his heart failure?

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Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

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Plsssssss helppppppp, what are observations of abnormalities in this heart, and what diseases might have contributed to this patients cause of death?
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