Question

CASE STUDY IN CARE OF DIVERSE CLINIS HEART FAILURE SCENARIO You are the nurse working in an internal medicine office or a thing to pl ay yow patient is 70-yearold JM, a man who has been coming to the cline for several years for management or coronary artery disease and hypertension. A cardiac catheterination des a year po showed 50% tesis of the circumflex commary artery. He has had episodes of dames for the months ldema, decreased exercise tolerance, and the inability to sleeping Man On his last eline visit 3 weeks ago, a chest x-ray examination revealed cardiomegaly You reviewIM's moming blood work and initial assessment CHART REVIEW Laboratory results Sodium Chloride Potassium Creatinine Glucose BUN 142 mEqL. 95 met 3.9 mot Normal 0.8 mg/dl 82 mg/dl 19 mg/dl Complete Blood Court 5400/mm3 Normal WBC Hgb Het Platelets 11.5 g/dl 37% low 229,000/mm3 Normal Initial assessment Complains of increased fatigue and shortness of breath, especially with activity, and "waking up gasping for breath at night, for the past 2 days Vital Signs Temperature Blood pressure Heart rate Respiratory rate 97.9F 162/94 high 110 beats/min high 24 breaths/min high

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Answer 1

2 Will ask the question; did the patient had any complaint of chest pain, tightness or discomfort . and the medication history and changes in any life style

3Yes he is having heart failure because history shows that the risk factors like smoking and hypertension , palpitation and constant irritant cough and orthopnoea

4 right side heart failure

5 Lisinopril 10 mg; it is an ACE INHIBITORS it works by relaxing blood vessels so the blood can flow more easily it is using for the heartfailure and hypertension

2 frusemide ; its adiuretics used to reduce the extra fluid in the body. using for heart failure

3 potassium cholride ; it is amineral supplement used to treat or prevent level of potsium in blood it is als essential for the heart mucsles

4 Amlodepine; it is aa anti hypertensive medicine to treat blood pressure it belongsto calcium chanel blockers it relax the heart muscles

5 Carvedilol; it is a Betablockers aftect the heart and circulation

6) Digoxin ; it is used to treat irregular heart beat s. it is cardiac glycoside

6 1/2 tab or will oder the other tab 10 mg

7 serum potassium and digxin level ; because the digoxine toxicity hyperkalemia will occur at the same time patient getting potassium chloride and digoxin it may leads to cardiac arrythmias ana even fatal condition also

8yes; the if the patient is ready to it banana e very day he can have instead of potassium tab because the studys shows imeq pottasium in 10 inchs banana

9 Ejection fraction means the percentage of blood pumped out from the left ventricle in each contraction . in this case 40% of the total amount of blood in the left ventricle is pushed out with each heart beat

10 Regular exercise eat heart healthy food , maiantan ahealthy weght, dnot drink alchol , regular monitoring of BP and weight fluid restiction as per the order and regular follow up

11we should explain him about the importants of salt restriction beacause it help to prevent heart failure and future heart porblems limiting salt intake controls the fluid around the heart' lungs and legs

12 b ,c, e