Question

A 74 year old woman is admitted to the hospital with heart failure. She had been growing progressively weaker, has ankle edema and dyspnea on exertion. On admission, she is severely dyspneic and can only answer with one word phrases. She is diaphoretic, heart rate 153 beats per min, blood pressure 100/72 mm Hg. She is extremely anxious. The physician orders a treatment plan to start an IV, push furosemide (Lasix) 40mg IV stat, digoxin 0.5 mg orally stat, morphine 2 mg IV stat, oxygen 4L min per nasal cannula, no added salt diet, weigh daily, monitor intake and output.

1. Explain the priority assessments upon admission.

2. Explain the symptoms the patient is a having related to the congestive heart failure.

Answer 1

1) As we see in this patient there is death of the heart muscle the area of infarct can be small or large depending upon the amount of the blood supply which was cut off and the treatment of the this patient is divided into 2 phases first the acute stage where the patient is in the ICU and the second phase of medical treatment is the rehabilitation stage. 2) Signs and symptoms of congestive heart failure: weiight gain , swelling of the feet, legs , ankles and hands and stomach, persistent cough or chest congestion, increasing fatigue and weakness , poor appetite, nausea , confusion, restlessness, intermittent shortness of breath, dizziness and light headedness, decreased blood pressure, jugular vein distention, weak pulse, S3 gallop, tachycardia, decreased urine output etc.