Case Study - CHF - Donald Bergman

CASE STUDY – HEART FAILURE Donald Bergman Patient Assignment D.B. is a 67-year-old male who was admitted to the telemetry unit 1 day ago for medical management with a diagnosis of chronic heart failure (HF). D.B. has a 20-year history of hypertension and had an MI 6 years ago. He began having fatigue, tachycardia, and dependent bilateral lower extremity edema about 18 months ago, and was diagnosed with right ventricular HF. He was already taking enalapril for hypertension and was prescribed furosemide, potassium, and digoxin after his HF diagnosis. D.B.’s symptoms have worsened over the last month. Upon admission 1 day ago at 0800 VS: T 36.4° C (97.5° F), BP 156/98, P 126 and regular, R 36 and labored. O2 saturation 88% on RA. He had 3+ pitting edema in his feet and ankles, dyspnea, tachycardia, JVD, and crackles bilaterally in his lungs. He stated that he has been unable to “get enough air,” has been sleeping in the recliner, and has gained 5.5 kg (12 lb) in the past month. Admission weight 100 kg (220 lb), height 177.8 cm (70 in). He is a full code. Admission Orders Enalapril 5 mg PO bid, digoxin 0.25 mg PO daily, potassium 20 mEq PO daily, valsartan 40 mg PO bid, furosemide 0.1 mg/kg/hr continuous IV infusion, O2 2L/min via nasal cannula to keep O2 saturation at or above 92%. Bed rest with bathroom privileges. 2000-calorie DASH diet. 1500 mL/day fluid restriction. Daily weights. I&O. CBC, BMP, BNP, cardiac enzymes, ECG, echocardiogram, and chest x-ray. Admit to telemetry unit with 24-hour monitoring. 1. What signs and symptoms did D.B. have 18 months ago when he was diagnosed with right ventricular HF? 2. What are some other signs and symptoms of right HF? ● ● 3. What do his current signs and symptoms (3+ pitting edema in his feet and ankles, 5.5 kg (12 lb) weight gain, dyspnea, tachycardia, JVD, orthopnea, and crackles bilaterally in his lungs) indicate? 4. As you begin your shift, what are your assessment priorities? 5. List at least three assessment questions that you will ask D.B. during your first encounter. 6. The intravenous (IV) furosemide is sent from the pharmacy mixed in a 50 mL bag with a concentration of 50 mg furosemide in 50 mL of D5W. What mL/hr will you set on the IV infusion pump for the furosemide 0.1 mg/kg/hr continuous IV infusion? Doctor’s order = 0.1mg/kg/hr 7. What dose of furosemide (mg/hr) is D.B. receiving? ............................................continued.......................................................