NSG2101: Pathophysiology- Congestive Heart Failure- Nursing Case Study Assignment

Internal Code: MAHOZ63

Nursing Case Study Assignment:

Task: Part A: For the given case study, design a concept map and work through EACH of steps 1- 3 of the clinical reasoning cycle to demonstrate an understanding for the physiology presented in the case study. Part B: Using your work from Part A, DISCUSS the comprehensive care of this patient incorporating each of the above learning outcomes. Identify three (5) PRIORITISED nursing problems. For EACH nursing problem, DESCRIBE the specific nursing activities, goals, rationales, and evaluations that you would incorporate when caring for this patient. Using evidence-based practice, research your interventions to ensure best practice in your nursing care. Case Study: M.G, a 68 year old female with frequent hospital presentations is admitted from the emergency department (ED) with a diagnosis of congestive heart failure (CCF). She was discharged from the hospital 11 days ago (March 12th 2018) and comes in today stating, “I just had to come to the hospital today because I can't catch my breath, my legs are as big as tree trunks and I am having difficulty walking.” After further questioning, you learn she has not been strictly following the fluid and salt restriction ordered during her last hospital admission and has not been compliant with her medication. You note that she has gained 5 kgs since her discharge. Past medical history: HT AMI 4 years ago Chronic renal failure Type 2 Diabetes Mellitus Hyperlipidaemia Family History Mother, died at age 65 years of CVA Father, died at age 67 years of acute myocardial infarction (AMI) Sister, alive and well, age 62 years Brother, alive, age 70 years, has coronary artery disease, HTN, type II diabetes mellitus (DM) Patient Past History Married for 45 years, two children, alive and well, six grandchildren Cholecystectomy, age 42 years Hysterectomy, age 48 years Recent Blood Pressure Assessments: January 2: 150/92 January 31: 156/94 (commenced on hydrochlorothiazide [HCTZ] 25 mg PO daily) February 28: 140/90 Current observations: P 122 irregular, BP 160/100, RR 26, T 37.3 C O2 Sats 93% on room air. Widespread crepitations on chest auscultation. Sweaty. Chest X Ray shows widespread consolidation and cardiomegaly. Atrial Fibrillation on ECG newly diagnosed. Apical pulse is fast and thready. Skin colour is pink. Oedema present ++ Nursing Assessment: Prescribed Medications: Captopril 25mg PO daily Hydrochlorothiazide [HCTZ] 25 mg PO every morning) Enalapril (Vasotec) 5 mg PO BD Furosemide (Lasix) 40 mg/ twice daily PO Potassium chloride 20 mEq/day PO Laboratory Test Results (Fasting) Potassium 5.3 mEq/L Sodium 145 mEq/L Chloride 100 mEq/L Bicarbonate 27 mEq/L Glucose 11.2 mmol Creatinine 4.5 mg/dL BUN 43 mg/dL Magnesium 1.9 mEq/ Radiology Results CXR shows cardiomegaly and pulmonary congestion ++