Circulation (Perfusion)
Heart Failure Clinical Reasoning Case Study
STUDENT Worksheet
Carlos Boccerini, 68 years old
Overview
This case study reflects a commonly seen complication of acute heart failure. The nurse must anticipate and
recognize which organ/body system is most at risk due to hypo-perfusion.
Concepts (in order of emphasis)
I. Perfusion
II. Gas Exchange
III. Fluid and Electrolyte Balance
IV. Clinical Judgment V. Patient Education
VI. Communication
VII. Collaboration
, Heart Failure That Progresses To …
I. Data Collection
History of Present Problem:
Carlos Boccerini is a 68-year-old male who has a 5-year history of systolic heart failure secondary to ischemic
cardiomyopathy with a current ejection fraction (EF) of only 15%. He presents to the emergency department
(ED) for shortness of breath (SOB) the past 3 days. His shortness of breath has progressed from SOB with
activity to becoming SOB at rest. The last two nights he had to sleep in his recliner chair to rest comfortably with
his head partially elevated. He is able to speak only a partial sentence and then has to take a breath when talking
to the nurse. He has noted increased swelling in his lower legs and has gained 6 pounds in the last 3 days. He is
being transferred from the ED to the cardiac step-down where you are assigned to care for him.
Personal/Social History:
Carlos has been married for 45 years and has four children. He is a retired baker who had to retire early due to
medical problems secondary to his progressive heart failure. His son is running the Italian bakery since Carlos
retired.
The family celebrated two birthdays this week and Jim made it to both parties. His wife does most of the cooking
at home and follows his need for sodium restrictions, but during the celebrations, Carlos made his own dietary
choices.
What data from the histories is important & RELEVANT; therefore, it has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
1. Mr. Boccerini has a 5-year history of 1. Mr. Boccerini’s heart is unable to pump sufficiently because of an
systolic heart failure secondary to alteration in the ability of the heart to contract
2. The ejection fraction is the percentage of blood volume in the ventricles
ischemic cardiomyopathy
at the end of diastole that is ejected during systole. It is a measurement
2. Ejections fraction of 15% of contractility and should be higher
3. Shortness of breath at rest 3. SOB can be due to inadequate cardiac output from heart failure
4. Sleeping in his recliner chair, with his 4. Difficulty breathing while lying flat, orthopnea, is a hallmark of heart
head partially elevated failure
5. Swelling in his lower legs 5. Swelling of the lower legs could be edema caused by increased
6. Gained 6 pounds in the last 3 days capillary pressure caused by CHF
6. Gaining weight quickly means that fluid is being retained (Nursing
Central, 2020)
RELEVANT Data from Social History: Clinical Significance:
He had to retire early due to his Mr. Boccerini has a history of progressive heart failure
progressive heart failure Sodium rich foods causes further retention of fluid
His wife does the cooking and
follows his need for sodium
restrictions
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• Atrial fibrillation 1. ASA 81 mg daily 1. Non-steroidal anti- 1. Binds irreversibly to
• Heart failure 2. Carvedilol (Coreg) inflammatory drug platelets and prevents
(systolic) 3.25 mg daily 2. Beta Blockers platelet aggregation. Used
to prevent heart attacks
secondary to 3. Ezetimide (Zetia) 10 3. Cholesterol 2. Used to treat congestive
ischemic mg daily absorption inhibitor heart failure
Heart Failure Clinical Reasoning Case Study
STUDENT Worksheet
Carlos Boccerini, 68 years old
Overview
This case study reflects a commonly seen complication of acute heart failure. The nurse must anticipate and
recognize which organ/body system is most at risk due to hypo-perfusion.
Concepts (in order of emphasis)
I. Perfusion
II. Gas Exchange
III. Fluid and Electrolyte Balance
IV. Clinical Judgment V. Patient Education
VI. Communication
VII. Collaboration
, Heart Failure That Progresses To …
I. Data Collection
History of Present Problem:
Carlos Boccerini is a 68-year-old male who has a 5-year history of systolic heart failure secondary to ischemic
cardiomyopathy with a current ejection fraction (EF) of only 15%. He presents to the emergency department
(ED) for shortness of breath (SOB) the past 3 days. His shortness of breath has progressed from SOB with
activity to becoming SOB at rest. The last two nights he had to sleep in his recliner chair to rest comfortably with
his head partially elevated. He is able to speak only a partial sentence and then has to take a breath when talking
to the nurse. He has noted increased swelling in his lower legs and has gained 6 pounds in the last 3 days. He is
being transferred from the ED to the cardiac step-down where you are assigned to care for him.
Personal/Social History:
Carlos has been married for 45 years and has four children. He is a retired baker who had to retire early due to
medical problems secondary to his progressive heart failure. His son is running the Italian bakery since Carlos
retired.
The family celebrated two birthdays this week and Jim made it to both parties. His wife does most of the cooking
at home and follows his need for sodium restrictions, but during the celebrations, Carlos made his own dietary
choices.
What data from the histories is important & RELEVANT; therefore, it has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
1. Mr. Boccerini has a 5-year history of 1. Mr. Boccerini’s heart is unable to pump sufficiently because of an
systolic heart failure secondary to alteration in the ability of the heart to contract
2. The ejection fraction is the percentage of blood volume in the ventricles
ischemic cardiomyopathy
at the end of diastole that is ejected during systole. It is a measurement
2. Ejections fraction of 15% of contractility and should be higher
3. Shortness of breath at rest 3. SOB can be due to inadequate cardiac output from heart failure
4. Sleeping in his recliner chair, with his 4. Difficulty breathing while lying flat, orthopnea, is a hallmark of heart
head partially elevated failure
5. Swelling in his lower legs 5. Swelling of the lower legs could be edema caused by increased
6. Gained 6 pounds in the last 3 days capillary pressure caused by CHF
6. Gaining weight quickly means that fluid is being retained (Nursing
Central, 2020)
RELEVANT Data from Social History: Clinical Significance:
He had to retire early due to his Mr. Boccerini has a history of progressive heart failure
progressive heart failure Sodium rich foods causes further retention of fluid
His wife does the cooking and
follows his need for sodium
restrictions
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• Atrial fibrillation 1. ASA 81 mg daily 1. Non-steroidal anti- 1. Binds irreversibly to
• Heart failure 2. Carvedilol (Coreg) inflammatory drug platelets and prevents
(systolic) 3.25 mg daily 2. Beta Blockers platelet aggregation. Used
to prevent heart attacks
secondary to 3. Ezetimide (Zetia) 10 3. Cholesterol 2. Used to treat congestive
ischemic mg daily absorption inhibitor heart failure
