heart failure: interactive fundamental clinical reasoning activity dara lanman, msn, rn, cne...
TRANSCRIPT
Heart Failure:Interactive Fundamental
Clinical Reasoning ActivityDara Lanman, MSN, RN, CNE
Assistant ProfessorGalen College of Nursing, Louisville, KY
You have been assigned to your patient this am and have been given report. Go to the Patient’s chart and review the most recent information regarding this patient.
Go to patient’s room
Patient’s Chart
Go to end of scenario questions
Patient’s Chart (click on what you want to review in your patient’s chart.)
Vital Signs
Patient History
Diagnostic Tests
Physician Orders
MAR
Patient History
Patient’s Chart
Main
It has now been 3 years since Mr. Kelly has been discharged from the hospital for CAD & MI. He is now 56 years old. He has not had any recurrent CP, but has had to sleep with 3 pillows to keep from becoming SOB at night the last 2 weeks. He has had difficulty getting his shoes on the last month because of increased swelling around his ankles. He forgets to take his medications every day. He weighs himself once a week and today his weight has increased from 255 lbs. to 264 lbs. the last 7 days. He makes an appt. through his clinic when he becomes concerned that he is now becoming SOB at rest and is more fatigued. The clinic physician recognizes that he will need acute inpatient care and coordinates a direct admission to the hospital by EMS.
PMH: heart failure, HTN, hyperlipidemia, CAD, MI, DM – type II
Diagnostic Tests:
Main
Patient’s Chart
Today Yesterday
Creatinine 2.1 1.2
Potassium 5.1 4.2
CXR: diffuse infiltrates consistent with pulmonary edema
Echocardiogram:Current ejection fraction is 30% with the most recent ejection fraction at 45%
HR RR Lung Sounds
BP Pulse Ox
0700 126 - regular
28 labored
Crackles 184/108 90% 2LNC
Main
Patient’s Chart
Main
Patient’s Chart
Physician Orders:Titrate oxygen for O2 sats >92%Insert Foley CatheterFurosemide 40 mg one time IV pushContinue home meds
Medication 0700-1500 1500-2300 2300-0700
Furosemide (Lasix)
090040 mg one time IV push
Simvastatin 0900 20 mg po daily
Glyburide 0900 10 mg po daily
HCTZ 090050 mg po daily
Lisinopril 090020 mg po daily
ASA 130081 mg po daily
Fish oil 13001000 mg po 2 tabs daily
Lasix HOLD TODAY40 mg po daily Main Patient’s Chart
Click on the drug to the left and you will be linked to a PDR for reference!
Neuro
Click on the buttons below to find out your assessment information.
Cardiac/Respiratory
GI /GU
Misc
Click on the buttons below to find out your assessment information.
Anxious, Alert & Oriented X4Temp 98.4
Cardiac/Respiratory
GI /GU
Misc
Click on the buttons below to find out your assessment information.
Cardiac – pale, cool to the touch, Pulses 2+ throughout, 2-3+ pitting edema lower extremitiesResp – course crackles scattered throughout both lung fields. Labored respiratory effort
Neuro
GI /GU
Misc
Click on the buttons below to find out your assessment information.
GI – Active bowel sounds in all 4 quads. Abd. Soft/non-tenderGU – Voiding without difficulty, urine clear/yellow
Neuro
Cardiac/Respiratory Misc
Click on the buttons below to find out your assessment information.
MISC- denies pain, skin integrity intact
First Question
Patient’s Chart
Main
Cardiac/Respiratory
Neuro
GI /GU
What is the relationship of your patient’s past medical history (PMH) and current medications? (Which medication treats which disease?)
On the next several slides, you will have some questions. Complete these questions and submit to your instructor per the instructions of your educator.
PMH: Heart failure HTN Hyperlipidemia CAD MI DM-type II
Home Medications: Simvastatin 20 mg po daily Glyburide 10 mg po daily HCTZ 50 mg po daily Lisinopril 20 mg po daily ASA 81 mg po daily Fish oil 1000 mg po 2 tabs daily Lasix 40 mg po daily
Next Question
Patient’s Chart
Main
One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, in your patient (if applicable) which disease likely developed first that then initiated a “domino effect” in their life? (Refer to the list of PMH listed for you in the patient history portion of the chart.
What came first:
What then followed:
Next Question
Patient’s Chart
Main
What is the relationship of your patient’s PMH and current chief complaint? What prior medical history above is relevant and likely influenced his current problem and chief complaint? Explain your rationale
Relevant PMH Rationale:
Next Question
Patient’s Chart
Main
What is the relationship between your patient’s chief complaint & identified primary medical problem? (look at pathophysiology and how it influences what you are seeing with your assessment findings)
Chief Complaint: Has had to sleep with 3 pillows to keep from becoming SOB at night the last 2 weeks. He has had difficulty getting his shoes on the last month because of increased swelling around his ankles. He weighs himself once a week and today his weight has increased from 255 lbs. to 264 lbs. the last 7 days. He makes an appt. through his clinic when he becomes concerned that he is now becoming SOB at rest and is more fatigued.
Relationship to primary medical problem:
Next Question
Patient’s Chart
Main
What is the relationship between your patient’s abnormal VS and assessment data & identified primary medical problem?
RELEVANT VS/assessment data:
Relationship to primary medical problem:
Next Question
Patient’s Chart
Main
What is the relationship between your patient’s RELEVANT abnormal diagnostic labs& identified primary medical problem?
RELEVANT Diagnostic results:
Relationship to primary medical problem:
Next Question
Patient’s Chart
Main
What is the relationship between the following physician orders/meds and your patient’s primary medical problem? (how will mech. of action of these meds/treatments impact this patient at a pathophys level to help resolve his primary problem?)
Physician orders:
Titrate oxygen for O2 sats >92%
Foley catheter
Furosemide (Lasix) 40mg IV push
How it will help resolve primary problem:
Next Question
Patient’s Chart
Main
What is the relationship between your patient’s RELEVANT abnormal diagnostic labs& identified primary medical problem?
RELEVANT Diagnostic results:
Relationship to primary medical problem:
Next Question
Patient’s Chart
Main
You have completed this scenario. Thank you for your hard work.