Question

Mr. H, an 82-year-old man who is widened and lives alone, arrives in the emergency room complaining he has had difficulty breathing, especially at night, associated with nausea, for the past week. He states that he must sleep with two pillows to breathe more easily at night and still does not get a good night’s rest. He also complains of cough that is worse at night and relieved by nothing. Mr. H has pneumonia. Assessment of Mr. H reveals the following;Vital signs: temperature, 98F; apical heart rate 86 beat s/min and irregular, respiratory rate, 36 breaths/min and labored; and blood pressure, 170/96 mmHgSkin – pale, cool, and diaphoresisInspiratory bibasilar crackles that do not clear with coughingS3, heart sound on auscultationVisible jugular vein distention3+ bilateral pedal edemaA 12-lead ECG and a chest x-ray examination are ordered. An intravenous line is started at a “keep vein oven” (KVO) rate. Oxygen via mask is admitted with a diagnosis of CHF.

1. What are the signs and symptoms of heart failure?

2. Give 7 lifestyle modifications to teach older adults with heart failure and discuss briefly.

3. Make a drug study on Digoxin including the nursing consideration.

4. Give 6 objectives with interventions (for each objective) in the management of CHF.

Answer 1

1) Palpitations

Diaphoresis

Dyspnoea on exertion

Orthopnea

Pink frothy sputum

B/l fine crepitations

Hepatomegaly

Kussmaul sign

2) eat healthy food with less fat

Have a walk daily

Do breathing exercises

Avoid smoking and alcohol

Don't exert much

Have a regular checkup of body

Drink more water

3) digoxin acts by increase in drive of intracellular sodium which causes increase in calcium in the cell, that increases the contractility of heart.

Due to this strong contractility action, it has great use in heart failure cases.