Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Gas Exchange
2. Fluid and Electrolyte Balance
3. Clinical Judgment
4. Patient Education
5. Communication
6. Collaboration
UNFOLDING Reasoning Case Study: STUDENT Heart Failure
History of Present Problem:
, JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four
years ago and systolic heart failure secondary to ischemic cardiomyopathy with a current
ejection fraction (EF) of only 15%. She presents to the emergency department (ED) for
shortness of breath (SOB) the past three days. Her shortness of breath has progressed from
SOB with activity to becoming SOB at rest. The last two nights she had to sleep in her recliner
chair to rest comfortably upright. She is able to speak only in partial sentences and then has to
take a breath when talking to the nurse. She has noted increased swelling in her lower legs and
has gained six pounds in the last three days. She is being transferred from the ED to the cardiac
step-down where you are the nurse assigned to care for her.
Personal/Social History:
JoAnn is a retired math teacher who is unable to maintain the level of activity she has been
accustomed to because of the progression of her heart failure the past two years. She has
struggled with depression the past two years and has been more withdrawn since her husband
of 52 years died unexpectedly three months ago from a myocardial infarction.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
MI four years ago, MI is significant because it decreases heart function
increase shortness of breath at due to death of myocardial muscle
rest; can only speak in partial EF of 15% shows that the heart is having a hard time
sentences, pumping blood out to rest of the body therefore starving it
ischemic cardiomyopathy with of oxygenated blood.
EF of 15% last two nights slept Weight gain and increased swelling signifies she is fluid
in recliner overloaded and it can be reason why she is having a hard
increased swelling in time talking, breathing, being
lower legs gained 6 active and why she has to sleep in a recliner the past 2
pounds in last 3 days nights
RELEVANT Data from Social Clinical Significance:
History:
Retired math teacher, recent widow, Depression might affect her enthusiasm to recover, to stick
history of depression, decreasing to a therapy regimen
activity level
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw
lines to connect)
PMH: Home Meds: Pharm. Expected Outcome:
Classification:
, • Diabetes mellitus type 1. ASA 81 mg PO • Antiplatelets • Decrease
II daily • Beta blocker chance of clot
• Hypertension 2. Carvedilol 3.25 • ACE inhibitor formation
• Choleste
• Atrial fibrillation mg PO daily • Decrease
• Hyperlipidemia rol blood
3. Lisinopril 5 medicati pressure
• Chronic renal mg PO daily on • Decrease blood
insufficiency 4. Ezetimide 10 • Vasodilator pressure, helps
(baseline creatinine mg PO daily • Diuretic with heart
2.0) 5. Hydralazine 25 • Electroly
te failure,
• Cerebral vascular mg PO 4x daily replacem decrease
accident (CVA) with 6. Torsemide 20 ent chance of
no residual deficits mg PO bid • Anticoagulant death from
• Heart failure 7. KCL 20 meq PO • Antidiabetic heart attack
daily
(systolic) • Decreas
8. Warfarin 5 mg PO
secondary to daily e
choleste
ischemic 9. Glyburide 5 mg rol
cardiomyopathy PO daily • Decrease
• MI with stent x2 to blood
LAD 4 pressure
years ago • Decrease
swelling,
decrease fluid
overload
• Increase serum
potassium
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller paulhans. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.99. You're not tied to anything after your purchase.
