heart failure exacerbation case study

QUESTION

Michael Granger is a 69-year-old male admitted to the medical unit from his cardiologist office for heart failure exacerbation. He was diagnosed with stage II Right Heart Failure last year and this is his 1^st exacerbation.

Pre-brief questions:

1. What are your primary concerns for this patient, and what assessments and nursing interventions would be associated with your concerns?

2. What do you anticipate the patient’s home medications might be prior to admission and why?

3. What medications do you anticipate the HCP (health care provider) may prescribe during the hospital admission and why?

4. What medications do you anticipate the HCP will prescribe at discharge and why?

ANSWER

Primary concerns for Michael Granger, a 69-year-old male admitted to the medical unit for heart failure exacerbation, would revolve around managing his heart failure symptoms, monitoring his cardiac status, preventing complications, and promoting his overall well-being. The following assessments and nursing interventions would be associated with these concerns:

Assessment and Nursing Interventions

Cardiac Monitoring: Continuous cardiac monitoring to assess heart rate, rhythm, and any signs of dysrhythmias or changes in cardiac status. This would help identify any potential complications or worsening of heart failure.

Vital Signs: Regular monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation to assess the patient’s hemodynamic stability and respiratory status.

Fluid Balance Assessment: Monitoring intake and output, daily weights, and assessing for signs of fluid overload or dehydration. This helps determine the effectiveness of diuretic therapy and guides fluid management.

Respiratory Assessment: Frequent assessment of respiratory effort, breath sounds, and oxygen saturation to detect any signs of respiratory distress or worsening of pulmonary congestion.

Medication Administration: Administration of prescribed medications, such as diuretics (e.g., furosemide) to promote fluid removal, vasodilators (e.g., nitroglycerin) to reduce cardiac workload, and inotropic agents (e.g., dobutamine) to improve cardiac contractility.

Symptom Management: Implementing measures to relieve symptoms such as dyspnea and fatigue, including positioning the patient in a semi-Fowler’s position, providing supplemental oxygen as needed, and assisting with activities of daily living.

Patient Education: Providing education on dietary modifications (e.g., low-sodium diet), fluid restriction, importance of medication adherence, and signs and symptoms to report to the healthcare team.

 Anticipated Home Medications

Prior to admission, Michael Granger’s home medications might include:

Diuretics: Diuretics such as furosemide to help manage fluid overload and reduce edema.

ACE Inhibitors/ARBs: Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to improve cardiac function and reduce blood pressure.

Beta-Blockers: Medications like metoprolol to control heart rate and decrease the workload on the heart.

Aldosterone Antagonists: Medications such as spironolactone to inhibit the effects of aldosterone, reducing fluid retention and promoting diuresis.

Digoxin: Used to improve cardiac contractility and manage symptoms of heart failure.

Anticipated Medications During Hospital Admission

During the hospital admission for heart failure exacerbation, the healthcare provider may prescribe additional medications to stabilize the patient’s condition and manage symptoms, such as:

Intravenous Diuretics: Intravenous administration of diuretics, such as furosemide, for more aggressive fluid removal.

Oxygen Therapy: Supplemental oxygen to improve oxygenation and alleviate respiratory distress.

Nitroglycerin: Administration of nitroglycerin to relieve chest pain and reduce cardiac workload.

 Inotropic Agents: Inotropic medications like dobutamine or milrinone may be prescribed to improve cardiac contractility.

Anticipated Discharge Medications

At discharge, the healthcare provider may prescribe medications to optimize heart failure management and prevent future exacerbations, which could include:

Optimized Diuretic Regimen: Adjustments to the patient’s diuretic regimen, with specific instructions on dosage, frequency, and monitoring of fluid balance.

ACE Inhibitors/ARBs and Beta-Blockers: Continued use of ACE inhibitors or ARBs and beta-blockers to maintain optimal cardiac function.

Aldosterone Antagonists: Continued use of aldosterone antagonists like spironolactone to manage fluid balance.

Digoxin: If indicated, the healthcare provider may continue or adjust the dosage of digoxin.

Medication Education: Detailed education on medication adherence, potential side effects, and the importance of regular follow-up with the healthcare provider.

In summary, the primary concerns for Michael Granger, admitted for heart failure exacerbation, involve managing his heart failure symptoms, monitoring his cardiac status, preventing complications, and promoting overall well-being. Assessments and nursing interventions would focus on cardiac monitoring, vital signs, fluid balance assessment, respiratory assessment, medication administration, symptom management, and patient education. Anticipated medications include diuretics, ACE inhibitors/ARBs, beta-blockers, aldosterone antagonists, and possibly inotropic agents. Discharge medications would aim to optimize heart failure management and prevent future exacerbations through medication adjustments and education.