Heart Failure
Home Health
Reasoning 1 of 2
FIRST Home Health Nurse
Visit
Frank Smith, 75 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
✓ Management of Care 17-23% ✓
✓ Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights
reserved.
, ✓ Basic Care and Comfort 6-12% ✓
Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights
reserved.
, ✓ Pharmacological and Parenteral Therapies 12-18% ✓
✓ Reduction of Risk Potential 9-15% ✓
✓ Physiological Adaptation 11-17% ✓
Initial Data to Review from Chart:
Current Problem/Reason for Home Health Care:
Frank Smith is a 75-year-old male who is 5 feet 10 inches tall (178 cm). His baseline weight is 255 lbs. (115.9 kg-36.6
BMI). He has a history of type II diabetes, myocardial infarction, hypertension and chronic systolic heart failure (ejection
fraction 40%) secondary to coronary artery disease.
Summary of Inpatient Admission:
Frank presented to the emergency department complaining of weakness, fatigue, decreased tolerance to activity, shortness of
breath with exertion, weight gain of three pounds in 24 hours, and productive cough with blood-tinged sputum.
Furosemide IV was administered to address fluid volume excess and 4500 mL fluid was removed. Before discharge, he is at
his baseline weight. Review of medication and nutrition therapy was provided before discharge and he had no questions.
Re-Hospitalization Risk Assessment:
This is Frank’s second inpatient admission in the last 30 days due to acute decompensated heart failure. He is discharged
with a diagnosis of pulmonary edema and exacerbation of chronic systolic heart failure. A referral was ordered for home
health care follow-up, and a registered nurse is scheduled to visit his home within 24 hours after discharge to assess patient,
determine medication adherence, and his understanding of management of heart failure.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Current Problem: Clinical Significance:
75-year-old male BMI 36.6 Unhealthy weight contributes to diabetes and heart disease
Type II diabetes, MI, HTN All are underlying issues that can lead to heart failure if not
Chronic systolic heart failure (40% EF) managed Left ventricle has become weak, not contracting properly,
not able to force blood out, only 40% of total blood
RELEVANT Data from Inpatient Admission: Clinical Significance:
Weak, fatigued, SOB, 3lb weight gain, s/s of left and right-side heart failure, based on Hx most likely left
productive cough with blood tinged sputum side HF (indicated by respiratory symptoms) progressed into right
side HF (indicated by weight gain), productive cough with blood
possible indicator of pulmonary edema
Furosemide IV administered; 4500 mL Loop diuretic for excess fluid removal, outcome as expected with 4500
removed, at baseline weight before discharge mL removed and pt back at baseline weight
Therapy provided, no questions asked Education is a priority for this pt, need to assess his understanding of
what was taught even if he has no questions
RELEVANT Data from Re-Hosp. Risk Assess: Clinical Significance:
second admission in 30 days High risk for same problem to keep reoccurring, education is priority
home health referral ordered Can assess pt at home, compliance with care plan, medication
adherence, and can educate and address any areas of deficit
Social History:
Frank is a retired engineer whose wife died unexpectedly one year ago after fifty years of marriage. He has become less
active since she died and rarely gets out of the house. Since his wife did most of the cooking, Frank mostly eats either
Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights
reserved.
Home Health
Reasoning 1 of 2
FIRST Home Health Nurse
Visit
Frank Smith, 75 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
✓ Management of Care 17-23% ✓
✓ Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights
reserved.
, ✓ Basic Care and Comfort 6-12% ✓
Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights
reserved.
, ✓ Pharmacological and Parenteral Therapies 12-18% ✓
✓ Reduction of Risk Potential 9-15% ✓
✓ Physiological Adaptation 11-17% ✓
Initial Data to Review from Chart:
Current Problem/Reason for Home Health Care:
Frank Smith is a 75-year-old male who is 5 feet 10 inches tall (178 cm). His baseline weight is 255 lbs. (115.9 kg-36.6
BMI). He has a history of type II diabetes, myocardial infarction, hypertension and chronic systolic heart failure (ejection
fraction 40%) secondary to coronary artery disease.
Summary of Inpatient Admission:
Frank presented to the emergency department complaining of weakness, fatigue, decreased tolerance to activity, shortness of
breath with exertion, weight gain of three pounds in 24 hours, and productive cough with blood-tinged sputum.
Furosemide IV was administered to address fluid volume excess and 4500 mL fluid was removed. Before discharge, he is at
his baseline weight. Review of medication and nutrition therapy was provided before discharge and he had no questions.
Re-Hospitalization Risk Assessment:
This is Frank’s second inpatient admission in the last 30 days due to acute decompensated heart failure. He is discharged
with a diagnosis of pulmonary edema and exacerbation of chronic systolic heart failure. A referral was ordered for home
health care follow-up, and a registered nurse is scheduled to visit his home within 24 hours after discharge to assess patient,
determine medication adherence, and his understanding of management of heart failure.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Current Problem: Clinical Significance:
75-year-old male BMI 36.6 Unhealthy weight contributes to diabetes and heart disease
Type II diabetes, MI, HTN All are underlying issues that can lead to heart failure if not
Chronic systolic heart failure (40% EF) managed Left ventricle has become weak, not contracting properly,
not able to force blood out, only 40% of total blood
RELEVANT Data from Inpatient Admission: Clinical Significance:
Weak, fatigued, SOB, 3lb weight gain, s/s of left and right-side heart failure, based on Hx most likely left
productive cough with blood tinged sputum side HF (indicated by respiratory symptoms) progressed into right
side HF (indicated by weight gain), productive cough with blood
possible indicator of pulmonary edema
Furosemide IV administered; 4500 mL Loop diuretic for excess fluid removal, outcome as expected with 4500
removed, at baseline weight before discharge mL removed and pt back at baseline weight
Therapy provided, no questions asked Education is a priority for this pt, need to assess his understanding of
what was taught even if he has no questions
RELEVANT Data from Re-Hosp. Risk Assess: Clinical Significance:
second admission in 30 days High risk for same problem to keep reoccurring, education is priority
home health referral ordered Can assess pt at home, compliance with care plan, medication
adherence, and can educate and address any areas of deficit
Social History:
Frank is a retired engineer whose wife died unexpectedly one year ago after fifty years of marriage. He has become less
active since she died and rarely gets out of the house. Since his wife did most of the cooking, Frank mostly eats either
Copyright © 2019 Keith Rischer, d/b/a KeithRN. All Rights
reserved.
