NURS 4700Lesson #3 CHF Case Study Meet your Patient Mr. M.: M., 70-year-old Franco-Canadian gentleman, now living in Oshawa; had been married for 45 years but has been recently widowed; was admitted to the medical unit with complaints of increasing dyspnea on exertion; retired since age 58; worked in underground mining since 18 years of age and has a 50 pack year history of smoking. Mr. M. has two children, a daughter lives in Manitoba and a son lives in Newfoundland. Subjective DataHad a severe MI at 58 years of ageHas experienced increasing dyspnea on exertion during the last 2 yearsRecently had a respiratory tract infection, frequent cough, and edema in legs over last two weeksLives on the third floor of apartment building with no elevatorCannot walk two blocks without getting short of breathHas to sleep with head elevated on three pillowsDoes not always remember to take medication Objective Data Physical ExaminationRespiratory distress, use of accessory neck muscles, respiratory rate 36 breaths/minHeart murmur S1 S2-Aortic systolic murmur III/VIMoist crackles in both lungsCyanotic lips and extremitiesSkin cool and diaphoreticAppears anxiousV/S 150/90, Pulse 88, RR 36/min. Temp 37 C, O2 Saturation 95% on room air. Diagnostic StudiesChest x-ray results: cardiomegaly with right and left ventricular enlargement; fluid in lower lung fields Physician’s orders for Mr. M.Lab work: Electrolytes, CBC, Creatinine, BUN,B-type naturietic peptide, troponin levels, lactic acidDigoxin 0.25 mg PO qdFurosemide (Lasix) 40 mg IV bidPotassium 40 mEq PO bidCaptopril (Capoten) 12.5 mg PO tid2 g sodium dietOxygen 6 L/minDaily weightsDaily 12-lead ECG, cardiac enzymes q8hr x 3 Lab Results for Mr. M.Potassium 3.4 mmol/LSodium 127 mmol/LChloride 87 mmol/LCreatinine 120 umol/LUrea nitrogen (BUN) 5 mmol/LLactic acid 4.0 mmol/LOsmolality 270 mmol/kgTroponin T (cTnT) <1.0 mcg/LHematocrit 0.28 volume fractionHemoglobin 130 g/LB-type naturietic peptide 105 ng/L Critical Thinking Questions:Explain the pathophysiology of Mr. M.’s heart disease.What clinical manifestations of heart failure is Mr. M. exhibiting?What is the significance of the findings of the chest x-ray?What is the significance of each of the lab values?What complications might occur as a result of Mr M.s heart failure?Explain the rationale for each of the medical orders prescribed for Mr. M. Is there anything missing from the orders that you believe needs to be included?What are appropriate nursing interventions for Mr. M.?What teaching measures should be instituted to prevent recurrence of an acute episode of heart failure?What Best Practice Guideline(s) should be considered?Considering all that is going on with Mr. M., what would you include in your discharge planning? What is going on at home? What is going on in his life?
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