Nursing Misc Cs Heart Failureemphasi E

JoAnn Smith, 72 years old


Primary Concept
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Perfusion
Interrelated Concepts (In order of emphasi
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NURSING MISC CS HEART FAILURE EXAM QUESTIONS AND AN=
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,NURSING MISC CS HEART FAILURE EXAM QUESTIONS AND AN
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s)
1. Gas Exchange
2. Fluid and Electrolyte Balance
3. Clinical Judgment
4. Patient Education
5. Communication

6. Collaboration

UNFOLDING Reasoning Case Study: STUDENT Heart

Failure`History`of` Present` Problem:
JoAnn` Smith` is` a` 72-year-
old` woman` who` has` a` history` of` myocardial` infarction` (MI)` four` years` ago` and` systolic`h`
eart` failure` secondary` to` ischemic` cardiomyopathy` with` a` current` ejection` fraction` (EF
)` of` only` 15%.` She` presents` to` the` emergency` department` (ED)` for` shortness` of` breath` (` SOB
)` the` past` three` days.` Her` shortness` of` breath` has` progressed` from` SOB` with` activity` to`b`
ecoming` SOB` at` rest.` The` last` two` nights` she` had` to` sleep` in` her` recliner` chair` to` re`st` c
o` mfortably` upright.` She` is` able` to` speak` only` in` partial` sentences` and` then` has` to` t` ake` a` br
` eath` when` talking` to` the` nurse.She` has` noted` increased` swelling` in` her` lower` l`egs` and` ha
` ` s gained` six` pounds` in` the` last` three` days.` She` is` being` transferred` from` the` ED` to` the` c` ar
diac` step-down` where` you` are` the` nurse` assigned` to` care` for` her.


Personal/Social` History:
JoAnn` is` a` retired` math` teacher` who` is` unable` to` maintain` the` level` of` activity` she` has


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, be` en` accustomed` to` because` of` theprogression` of` her` heart` failure` the` past` two` years.`She`
h




NURSING MISC CS HEART FAILURE EXAM QUESTIONS AND AN=` S
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, NURSING MISC CS HEART FAILURE EXAM QUESTIONS AND AN=` S
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as` struggled` with` depression` the` past` two` years` and` has` been` more` withdrawn` since` her`h`
usband` of` 52` years` died` unexpectedly` three` months` ago` from` a` myocardial` infarction.


What` data` from` the` histories` is` RELEVANT` and` has` clinical` significance` to` the` nurse?
RELEVANT Data from Present
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Problem:
MI` four` years` ago, MI`is`significant`because` it` decreases` heart` functi`on
increase` shortness` of` breath` at` re`st; ` due` to` death` ofmyocardial` muscle
` can` onlyspeak` in` partial` sent`e`nces EF`of`15%`shows`that`the`heart`is`having`a`hard`time`pumpi
, ng` blood` out` torest` of` the` body` therefore` starvi` ng`it` of` o
ischemic` cardiomyopathy` with`E` xygenated` blood.
F` of` 15%last` two` nights` slept`i` Weight` gain` and` increased` swelling` signifies` she` is` flu` i`
n` recliner d` overloaded` and` it` can` be` reason` why` she` is` having` a`h
increased` swelling` in` lo`w`e ard` time` talking,` breathing,` being
r` legsgained` 6` poun active` and` why` she` has` to` sleep` in` a` recliner` the` past` 2
ds` in` last` 3` days nights

RELEVANT Data from Social H Clinical Significance:
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istory:
Retired`math`teacher,`recent`wido` Depression` might` affect` her` enthusiasm` to` recover,` to`st
w,`history`ofdepression,`decreasin` `ick`to` a` therapyregimen
g` activity` level


What` is` the` RELATIONSHIP`of` your` patient’s` past` medical` history` (PMH)` and` current=`me`d
=s?
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