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I.
Introduction Congestive Heart Failure may eventually lead to Heart Failure. Heart Failure
is a physiologic state in which the heart cannot pump enough blood to meet the metabolic needs of the body (determined as oxygen consumption). Heart Failure results from the changes in systolic or diastolic function of the left ventricle. The heart fails when, because of intrinsic disease or structural defects, it cannot handle a normal blood volume or, in the absence of disease, cannot tolerate a sudden expansion in blood volume (e.g during exercise). Heart failure is not a disease itself; instead the term refers to a clinical syndrome characterized by manifestation of volume overload, inadequate tissue perfusion, and poor exercise tolerance. Whatever the cause, pump failure results in hypoperfusion of tissue, followed by pulmonary and systemic venous congestion, it is often called congestive heart failure, although most cardiac specialists no longer use this term. Other term used to denote heart failure include chronic heart failure, cardiac decompensation, cardiac insufficiency, and ventricular failure. Congestive Heart Failure (CHF) is the inability of the heart to pump oxygenated blood to different muscles, tissues and organs due to weakening of hearts muscles leading to retention of oxygenated blood in the lower chamber of the heart (left ventricle) and lungs. This weakened pumping action of the heart causes accumulation of body fluid (water) in the lungs, kidneys, arms, legs ankles and feet. Congestive heart failure is mainly due to:
Systolic Dysfunction When heart cannot pump oxygenated blood to suffice the bodys needs Diastolic Dysfunction When heart is unable to accept all the blood being sent to it.
In the said article that we have read, Congestive heart failure estimated at least 300,000 Australians currently suffer Congestive heart failure (CHF) and around 30,000 new cases are diagnosed each year; Heart failure is generally a disease affecting the older generation - 13 per cent of people aged 65 and over presenting to a GP suffer heart failure; In 1996 and 1997, 41,000 hospitalisations reported congestive heart failure as a principal diagnosis; During 1996 and 1997 congestive heart failure contributed to 2 per cent of all deaths;
Congestive heart failure has been estimated to account for $411 million of the total direct health costs attributed to cardiovascular disease. This figure for CHF includes $140 million per year on hospitalisation and $135 million per year on nursing home costs;
Congestive heart failure is the only major cardiovascular disease that still has an increasing incidence and prevalence, and the number of cases of heart failure in regions worldwide reflects this: The statistics of Congestive heart failure is estimated to be as many as 20 individuals per 1,000, rising to as many as 130 individuals per 1,000 for those aged over 65 years; In Western Europe there are over five million congestive heart failure patients, whilst in the USA there are around five million heart failure sufferers, with 400,000 new cases of congestive heart failure diagnosed each year; The number of new cases of heart failure reported in Europe every year is approximately two to three per 1,000; Worldwide among the 70-80 age group, one hundred people per 1,000 have heart failure. The incidence and prevalence of heart failure is still rising and it is predicted that this will continue. There are two main reasons for this increase: 1) Advances of modern medicine: The improved management of cardiovascular disease means that patients now survive longer. Many patients who have heart attacks are now surviving them because of modern medical treatment and more rapid response times from medical services. However, the heart muscle of these patients is often damaged and can no longer compensate, leading to the development of heart failure. This has been described as an "ironic failure of success". 2) Ageing of the population: Older people have a much higher prevalence of heart failure than younger individuals, which may be due to the greater frequency of common risk factors for heart failure, such as hypertension, myocardial infarction (heart attack) and diabetes mellitus. Among those aged over 80 years, the prevalence of heart failure reaches one in ten. In Europe, the average age of the population in 1950 was 29.2 years however by 1998 this had risen to 37.1 years. By 2050, the average age of
the population is predicted to reach 47.7 years, leading to a higher incidence of heart failure. Source: http://www.virtualcancercentre.com/diseases.asp?did=485
Our group choose CHF as our case study because this is the usual cases that patient is being admitted at the ward and because of this, the group have searched that Heart failure affects about 5 million people in the United States, with 500,000 new cases diagnosed each year. In contrast to decreases in mortality associated with other cardiovascular diseases, the incidence of heart failure and the mortality associated with it have increased steadily since 1975. Annually about 300,000 clients die from direct or indirect consequences of heart failure, and the number of deaths attributed to heart failure has increased six-fold over the past 40 years. Heart failure can affect both women and men, although the mortality is higher among women. There are also racial differences; at all ages death rates are higher in African Americans than in non-Hispanic whites. Heart failure is primarily a disease of older adults, affecting 6% to 10% of those older than 65. It is also the leading cause of hospitalization in older people.
I.
NURSING ASSESSMENT
A. ASSESSMENT 1. PERSONAL DATA. Mr. Labdab is 58 years old and was born on july 58, 1952 at
somewhere in Angeles City. And he was the 3rd child of the family, all family members are Filipino citizen and member of Roman Catholic. by a young age he already started to work and hold the financial responsibilities for his family, because his two sisters got married at an early age and were separated to have their own family ways of living. Mr. Labdab spent his adolescence year working in a public market. And he was admitted at Ospital Ning Angeles and had a chief complains of chestpain, difficulty of breathing and excessive vomiting with the admitting diagnosis of t/c CHF, t/c BAIAE and t/c Electrolyte imbalance.
2. PERTINENT FAMILY HISTORY

The Heart family has nuclear type of family consisting of 5 members (including parents and their children). On Labdab fathers side, his grandfather died at the age of 87 because of heart attack. His grandmother died by the age 86 and suffered from hypertension. The eldest sibling is 89 year old female who is suffering from the same condition like his father. The second sibling is 88 year old female who has a history of having Urinary tract infection and hypertension. Next to him is 86 year old female who is suffering from gouty arthritis at the right lower extremities which started last February 2007 and had a checked-up at a hospital somewhere in Angeles City. The youngest sibling is also female, 84 years old with no health complains.
On Labdab mother side, his grandmother, died at the age of 84 and suffered from rheumatoid arthritis. His grandfather, died by the age of 90 years old, who suffered from hypertension due to frequently smoking. Mr. Labdab is the 3 rd child of Mrs.S1, his eldest sister who is 64 years old is suffering from Diabetes mellitus, his second sister who is 62 year old has no history of major illness, and his second youngest sister died by the age of 57 due to VA and his youngest sister has no medical illness history.
Mr.Labdab and Mrs.Lab-shh were married almost 28 years ago. Mr. Labdam works in the market and earns 8,000 per month except for their other bonuses. Mrs. Lab-shh is a housewife taking care of their child, doing household chores and a beautician as her part time job. They live in a bungalow house with 2 bedrooms, 1 bathroom and 2 windows as stated by Mr.Labdab. They eat three times a day and they usually eat together as a sign of their close family ties bound with familial love and trust. They believed that ampalaya help in their recoveries from common colds and Guava to cure diarrhea and aid in wound healing. The family believes in the curing abilities of manghihilots and mananawas and usually consults to them first before seeking for professional advice. Despite of their practice of superstitious belief, they dont hold them as their basis in living their lives because they strongly believe in God and He is the only one who serves as their source of strength. Thus, they always see to it that their whole family goes to church every Sunday morning. This is to show their devotedness to God.
3. PERSONAL HISTORY
According to Mr.Labdab, he usually visits their health center to seek for health care services when he feels something unusual. Among his health habits are taking a bath everyday, cleaning their house, eating lots of foods, and smoking after waking up, before and after eating, because he believes that smoking helps him to metabolized easily the food or what other term as pampa tunaw ng kinain. According to him, his favorite foods are: meat, chicken, suman and fruits like bayabas, papaya and avocado. He told us that he usually feels back pain due to prolong standing on his work and carrying heavy objects especially boxes of can goods.
GROWTH AND DEVELOPMENT

Erik Erickson (Psychosocial Theory) Mr.Labdab is in the Generatively vs. Stagnation of Erik Ericksons Growth and Development Stage. In this stage, Those who are successful during this stage will feel that they are contributing to the world by being active in their home and community. Those who fail to attain this skill will feel unproductive and uninvolved in the world
Mr. Labdab seem to be feel productive on his life, as he currently have a position to be the barangay tanod on their barrio. According to him, he is dedicated toward his work and have a sincere concern to his fellow-men.
Grandfat Grandfath Auntie1 Grandmother Grandmothe Uncle 1 Uncle 2 Aunt 3 Mrs. Mr. Hearted Broken (72 (83 (87 (87 y/o) (88 erry/o) her 1 4 5 3 (84 Typhoid ( Gouty (85 y/o) (65 y/o) (67 (66 (68 y/o) (90 69y/o) Suffered y/o) UTI (86 (36 y/o) Arthritis Suffered y/o) Fever Died, Suffered Died from because suffered Rheumatoid UTI from from Hypertens Hypertensio of Arthritis from heart hyperten attack ion n sion Uncle 1 (89 y/o) Hypertensi Uncle 2 (71 y/o)
Mr.Labdab ( 58 y/o) Congested heart
IMMUNIZATION STATUS Mr. Labdab immunization is complete. He received BCG, 3 doses of OPV, 3 doses of DPT 3 doses of Hepa B and Measle.
4. HISTORY OF PAST ILLNESS

According to Mr. Labdab he suffered from chronic hypertension and was admitted last September 23, 2007 at hospital somewhere in Angeles City, aside from this major illness he also mention that, he sometimes feel fatigue and get tired easily due to his work. Aside from those he also experienced common colds and used pararacetamol to relieve the colds.
5. HISTORY OF PRESENT ILNESS

The patient experienced signs and symptoms of bronchial asthma such as: low grade fever, productive cough, colds, positive rales on both lungs and the use of accessory muscle. He also experiencing chest-pain and easily get tired on his work time.
6. PHYSICAL ASSESSMENT (IPPA Ceaphalocaudal Approach)

Head: -hair is black, , hair is evenly distributed over scalp, shows no tenderness, no presence of lice, face is symmetrical. Eyes and Vision: Eyebrows - symmetrically aligned, evenly distributed. Eyelashes - evenly distributed, curled slightly outward. Conjunctiva - pinkish and moist. Nose: -Symmetrical nasal nares. with partial obstruction on one nares upon occlusion.
Ears:
-There is presence of minimal cerumen upon inspection; no redness and lesions. Mouth: Teeth- incomplete teeth. Buccal cavity and palates- pink; no presence of lesions Tongue- dry Neck: No head lag; has the ability to control his head. Chest and Lungs: Lung sounds- crackles on inspiration upon auscultation - Dull upon percussion because of presence of secretions. Heart: Abnormal heart rate. Abdomen: -Presence of bowel sounds upon auscultation; there was no tenderness; slightly distended. Genitorectal Area: Pt. refuse to the assessment Extremities: Upper: with pallor and negative to cyanosis; warm to touch; Absence of tenderness upon palpation,
Lower: with pallor and negative to cyanosis; warm to touch; has varicosities, and non-pitting edema.
DIAGNOSTIC AND LABORATORY PROCEDURES

DIAGNOSTIC/LABORA TORY PROCEDURES DATE OREDERED INDICATIONS/P URPOSES RESUL TS NORMAL VALUES ANALYSIS AND INTERPRETA
DATE RESULTS
TION
Sodium
Date ordered: 08-08-10
Date results: 08-08-10
Blood sodium testing is used to detect hyponatremia or hypernatremia associated with dehydration, edema, and a variety of diseases. Your doctor may order this test, along with other electrolytes, to screen for an electrolyte imbalance. Potassium testing is frequently ordered, along with other electrolytes, as part of a routine physical. It is used to detect concentrations that are too high (hyperkalemia) or too low (hypokalemia).
113.7
135-150 mEq/L
The sodium level is low which the patient has electrolyte imbalance: hyponatremi a.
potassium
4.1
3.5-5.2 mEq/L
Potassium level is at the normal level..
The most common cause of hyperkalemia is kidney disease, but many drugs can decrease potassium excretion from the body and result in this condition.
creatinine
The creatinine test is used to diagnose impaired renal function and to determine renal damage
0.9
0.4-1.4
The creatinine level is within the normal level.
T. Bilirubin
0.5
0.2-1.2
The T bilirubin level is within the normal level.
D. Bilirubin
0.1
0-0.5
The D bilirubin level is within the normal level
L. Bilirubin
0.4
0.2-0.8
The L bilirubin level is within the normal level
Alk. phos
35.7
35-123
The alk. Phos level is within the normal range.
SGPT/ALT
Date ordered:
15.5
Up to 38 lu/ml
The SGPT/ALT level is
08-08-10
within the normal range.
SGOT/AST
20.9
Up to 40 lu/ml
The SGOT/AST level is within the normal level.
Nursing Responsibilities: Prior to Procedure: Check the doctors order. Verify patients name. Explain the procedure. Explain the purpose and what to expect. No food or fluid restrictions.
During the Procedure: Do not take the blood sample from hand or arm with receiving IVF. The tourniquet should be less on a minute. Do not squeeze the punctured site rightly. Wipe away the first drop of blood. Collect a venous blood on a tube or container. clean
After the Procedure: Observe and record vital signs. Check injection sites for bleeding, infection, tenderness or thrombosis. Report untoward reaction to the physician. Apply warm compress to ease discomfort, as ordered. Encourage relaxation by allowing client to discuss experience and verbalize feelings. Interpret results and provide counsel appropriately. Provide health teachings regarding proper lifestyle changes.
DIAGNOSTIC/ LABORATOR Y PROCEDURE S
DATE OREDERED DATE RESULTS
INDICATIONS/PURP OSES
RESULT S
NORM AL VALUE S
ANALYSIS AND INTERPRETATION
Hemoglobin Date ordered: 08-08-10 08-09-10
This test evaluates blood loss, erythropoietin ability, anemia and response to therapy. It is an Date results: 08-08-10 08-09-10 important component of RBC that carries oxygen and CO2 to and from the tissues. 08-0810: 149 08-0910: 167
140180 gm/L
The hemoglobin level is at normal range.
Hematocrit
Date ordered: 08-08-10 08-09-10
Measures the concentration of RBC within the blood volume. It is used to aid 08-0810:
0.400.54 gm/L
The hemotocrit level is at normal range.
diagnosis abnormal Date results: 08-08-10 08-09-10 states of dehydration, polycythemia and anemia.
0.46 08-0910: 0.50
WBC Count
Date ordered: 08-08-10 08-09-10
Test used to detect infection or inflammation to evaluate effectiveness of antibiotic prescribed. 08-0910: 17.3 08-0810: 10.0
5-10 x109/L
Increased in WBC. This indicates the bodys defense mechanism in fighting infection.
Date results: 08-08-10 08-09-10
RBC Count Date ordered: 08-08-10 08-09-10
To know if there is proper delivery of oxygen to the body tissues via the blood.
08-0810: 5.20 08-0910:
4.56.3 x10 L
The RCB level is at normal range.
Date results: 08-08-10 08-09-10
5.56
Nursing Responsibilities for Blood Hematology: Prior to Procedure:
Check the doctors order Verify patients name Inform the patient that the test is used to evaluate anemia and hydration status and to monitor therapy. Obtain a history of the patients complaints, including a list of known allergens (especially allergies or sensitivities to latex), and inform the appropriate health care practitioner accordingly.
Obtain a history of patient as well as the previous performed laboratory tests, surgical procedures and other diagnostic procedures. Secure a laboratory request. Explain the test and why it is needed. There are no food, fluid, or medication restrictions, unless by medical direction.
Explain to the patient that it is normal for the patient to feel pain and some discomforts while performing the procedure. Consider the patients cultural beliefs and practices.
During the Procedure: Instruct the patient to cooperate fully and follow directions. Direct the patient to breathe normally and to avoid unnecessary movement. Avoid using equipment containing latex if the patient has allergy to it. Observe standard precautions. Remove the needle, and apply a pressure dressing over the puncture site. Promptly transport the specimen to the laboratory for processing and analysis.
After the Procedure: Observe venipuncture site for bleeding or hematoma formation. Apply paper tape or other adhesive to hold pressure bandage in place or replace with a plastic bandage. Instruct the SO to apply pressure to the puncture site until bleeding stops. Assess the site for hematoma formation. Document the test performed.
DIAGNOSTIC/LABO RATORY PROCEDURES
DATE OREDE RED DATE RESULT S
INDICATIONS/PU RPOSES
RESULTS
NORMAL VALUES
ANALYSIS AND INTERPRETA TION
urinalysis
Date ordered: 08-0810 Date results: 08-0810
It is used for the screening of the abnormalities within the urinary system and ordered to determine whether the urine contains substances indicate of normally absent from urine and detected by urinalysis are proteins, glucose acetone, blood, pus and casts
Color : Yellow
Yellow
Urine color is within normal range
Transparenc y: clear
Clear
Urine transparenc y is normal.
Urine PH is Ph : 5.0 4-6.8 within the normal range
Sp Gravity is Sp Gravity : 1.015 1.05-1.030 within the normal range
Sugar : negative Negative
Sugar is in abnormality
Urine Albumin : Trace albumin is Normal/Trac e not within the normal range it may lead to kidney failure and water loss because albumin is a big protein component.
Pus cells are within normal Microscopic findings: range.
Pus cells : Urine RBC is 0-2 within
normal RBC: 0-2 0-3 range.
Less than 2 Casts/LFP hyaline cast: 6-8
Epithelial Epithelial Cells : Rare cells above normal range. is
Few
Nursing Responsibilities for Urinalysis Prior to the Procedure Inform the patient that the test is used to assist in the diagnosis of renal diseases and as an indication of inflammatory diseases. Obtain a history of the patients genitourinary, surgical procedures and other diagnostic procedures. Obtain a list of medication the patient is taking.
Review the procedure with the patient. There are no food, fluid or medication restrictions, unless by medical direction.
During the Procedure Instruct the patient to thoroughly wash his hands, cleanse the meatus, void a small amount in the toilet and void directly into the specimen container. Promptly transport the specimen to the laboratory for processing and analysis.
After the Procedure Instruct the patient to report symptoms such as pain related to tissue inflammation, pain or irritation during void or alterations in urinary elimination. Answer any questions or address any concerns voiced by the patient or family. Evaluate test results in relation to the patients symptoms and other test performed.
DIAGNOSTIC/LABORA TORY PROCEDURES
DATE OREDE RED DATE RESULT S
INDICATIONS/PUR POSES
RESULT S
NORMA L VALUE S
ANALYSIS AND INTERPRETA TION
Date ordered:
Electrocardiogram (ECG)
08-0810 Date results: 08-0810
This test is performed due to his diagnosis of CHF. It will help if there is any cardiac problem and abnormalities in his heart rhythm.
Rate: 70/min Rhyth m: Sinus Axis: Normal PR: 0.16 sec QRS: 0.08 sec QT: 0.36 sec
Normal sinus rhythm AL: 60100/mi n PR: 0.120.20 sec QRS: 0.040.11 sec QT: Male: up to 0.42 sec
Based from the interpretatio n of the ECG, the patient has AnteriorLateral Wall Ischemia, it usually occurs as a result of a blockage in one of the arteries supplying the portion of the heart muscle with oxygen. Since the patient is diagnosed of CHF this could lead to Ischemia or decreased oxygen going to brain.
Nursing Responsibilities for Using an Electrocardiogram:
Prior to Procedure: Ask for the patients name. Explain to the patient the purpose and how the procedure will be done. Reassure patient that it is painless and small disks (electrodes) will be placed on the chest and extremities. Tell the patient to lay still her back (supine) while ECG machine is recording the hearts activity. Explain that the chest wall will be exposed during the procedure. Be aware that identify, the person should rest for 15 minutes before the ECG recording. Have the patient avoid heavy meals and smoking for at least 30 minutes before the ECG and longer if possible. Remove any metal like coins in the pocket or anything that can conduct electricity. However, reassure that ECG does not deliver/permit electricity to enter the body nor is there any sensation of electrical shock. Check the machine if it is functioning well. Have the patient completely relaxed before the procedure to ensure satisfactory tracing. Wipe the site wherein you will place the electrodes with alcohol. During the Procedure: Make sure that the electrodes are properly placed on chest wall and connected by wires to the ECG machine. Assist the tracing paper; make sure it is not crumples inside the machine.
After the Procedure: Remove the electrodes carefully. Wipe off electrode paste or jelly if it was used. Assist the patient in putting her clothes, then drape the patient properly. Review exercise tolerance and cardiac rehabilitation program in client if results indicate cardiac disease. Recognize the limitations of ECG. It does not rule out any cardiac diseases and does not always signify heart disease. This is due to the following interfering factors:
a. Improperly grounded recording equipment distorts electrical tracing. b. Improper placememnt of electrodes; inadequate or dry conduction gel or alcohol. c. Movement of client d. Heavy chest hair e. Anxiety or fear f. Food intake g. Deep respiration h. Drug intake / indications i. Electrolyte imbalance Let the professional interpret the test results and monitor the patient appropr
I.
ANATOMY AND PHYSIOLOGY
The center of the circulatory system is the heart, which is the main pumping mechanism. The heart is made of muscle. The heart is shaped something like a cone, with a pointed bottom and a round top. It is hollow so that it can fill up with blood. An adults heart is about the size of a large orange and weighs a little less than a pound.
The heart is in the middle of the chest. It fits snugly between the two lungs. It is held in place by the blood vessels that carry the blood to and from its chambers. The heart is tipped somewhat so that there is a little more of it on the left side than on the right. The pointed tip at the bottom of the heart touches the front wall of the chest. Every time the heart beats it goes thump against the chest wall. You can feel the thumps if you press there with your hand. You can also listen to them with your ear. Structure of the Heart If you looked inside your heart, you would see that a wall of muscle divides it down the middle, into a left half and a right half. The muscular wall is called a septum. The septum is solid so that blood cannot flow back and forth between the left and right halves of the heart. Another wall separates the rounded top part of the heart from the cone-shaped bottom part. So there are actually four chambers (spaces) inside the heart. Each top chamber is called an atrium (plural: atria). The bottom chambers are calledventricles. The atria are often referred to as holding chambers, while the ventricles are called pumping chambers. Thus, each side of the heart forms its own separate system, a right heart and a left heart. Each half consists of an atrium and a ventricle, and blood can flow from the top chamber to the bottom chamber, or ventricle, but not between the two sides. The Valves Blood can flow from the atria down into the ventricles because there are openings in the walls that separate them. These openings are called valves because they open in one direction like trapdoors to let the blood pass through. Then they close, so the blood cannot flow backwards into the atria. With this system, blood always flows in only one direction inside the heart. There are also valves at the bottom of the large arteries that carry blood away from the heart: the aorta and the pulmonary artery. These valves keep the blood from flowing backward into the heart once it has been pumped out. Branching Blood Vessels The heart is a pump whose walls are made of thick muscle. They can squeeze (contract) to send blood rushing out. The blood does not spill all over the place when it leaves the heart. Instead, it flows smoothly in tubes called blood vessels. First, the blood flows into tubes called arteries. The arteries leaving the heart are thick tubes. But the arteries soon branch again and again to form smaller and smaller tubes. The smallest blood vessels,
called capillaries, form a fine network of tiny vessels throughout the body. The capillaries have extremely thin walls so that the blood that they carry can come into close contact with the body tissues. The tiny red blood cells can then pass easily through the walls of the capillaries to deliver the oxygen they carry to nearby cells. As the blood flows through the capillaries, it also collects carbon dioxide waste from the body cells. The capillaries containing carbon dioxide return this used blood to the heart through a different series of branching tubes: The capillaries join together to form small veins. The veins, in turn, unite with each other to form larger veins until the blood from the body is finally collected into the large veins that empty into the heart. So the blood vessels of the body carry blood in a circle: moving away from the heart in arteries, traveling to various parts of the body in capillaries, and going back to the heart in veins. The heart is the pump that makes this happen. The Circulation of Blood The human circulatory system is really a two-part system whose purpose is to bring oxygen-bearing blood to all the tissues of the body. When the heart contracts it pushes the blood out into two major loops or cycles. In the systemic loop, the blood circulates into the bodys systems, bringing oxygen to all its organs, structures and tissues and collecting carbon dioxide waste. In the pulmonary loop, the blood circulates to and from the lungs, to release the carbon dioxide and pick up new oxygen. The systemic cycle is controlled by the left side of the heart, the pulmonary cycle by the right side of the heart. Lets look at what happens during each cycle: The systemic loop begins when the oxygen-rich blood coming from the lungs enters the upper left chamber of the heart, the left atrium. As the chamber fills, it presses open themitral valve and the blood flows down into the left ventricle. When the ventricles contract during a heartbeat, the blood on the left side is forced into the aorta. This largest artery of the body is an inch wide. The blood leaving the aorta brings oxygen to all the bodys cells through the network of ever smaller arteries and capillaries. The used blood from the body returns to the heart through the network of veins. All of the blood from the body is eventually collected into the two largest veins: the superior vena cava, which receives blood from the upper body, and the inferior vena cava, which receives blood from the lower body region. Both venae cavae empty the blood into the right atrium of the heart.
From here the blood begins its journey through the pulmonary cycle. From the right atrium the blood descends into the right ventricle through the tricuspid valve. When the ventricle contracts, the blood is pushed into the pulmonary artery that branches into two main parts: one going to the left lung, one to the right lung. The fresh, oxygen-rich blood returns to the left atrium of the heart through the pulmonary veins. Although the circulatory system is made up of two cycles, both happen at the same time. The contraction of the heart muscle starts in the two atria, which push the blood into the ventricles. Then the walls of the ventricles squeeze together and force the blood out into the arteries: the aorta to the body and the pulmonary artery to the lungs. Afterwards, the heart muscle relaxes, allowing blood to flow in from the veins and fill the atria again. In healthy people the normal (resting) heart rate is about 72 beats per minute, but it can go much higher during strenuous exercise. Scientists have estimated that it takes about 30 seconds for a given portion of the blood to complete the entire cycle: from lungs to heart to body, back to the heart and out to the lungs.
PATHOPHYSIOLOGY (BOOK CENTERED) A. SCHEMATIC DIAGRAM
PATHOPHYSIOLOGY OF CONGESTED HEART FAILURE (BOOK CENTERED)
Non modifiable factors
Modifiable Factors
Family History Sex Age
Smoking Raised blood cholesterol level High blood pressure Physical Inactivity Overweight and Obesity Alcoholism Increase sodium intake
__________________________________________________________________
Genetic predisposition
Cell membrane alteration
Functional Vasoconstriction
Increased peripheral pressure
Hypertension (Increased BP)
Vasoconstriction of blood vessels
__________________________________________________________________
Vasoconstriction of Coronary arteries
increase after loads
Increase workload
Increase pressure Of blood flow Increase of LV contraction
Injury of the endothelial ventricle Vessel
Increase CO
increase strees on LV
---------------------------------LV hypertrophy
Vessel damage hypoxia
Ventricular remodeling
LV
Monocytes, platelets, cholesterol And other blood
LV ventricular
Increase residual blood of Scarring LV during diastole
Atherosclerosis pressure
increase LV
CA from LV
blood back flows During
diastole
Decrease cardiac tissue pressure Blood flow
decrease brain perfusion: dizziness, light headedness, anxiety, restlessness, decrease Response to energy demand causing
Increase LA
Blood returns to pulmonary Circulatio n
Decrease cardiac muscle Contraction blood in the pulmonary bed Decrease CO Accumulation of Capillary
Activation of baroreceptors In the LV, Aortic dypnea, cough, orthopnea
Decrease systemic Blood pressure pulmonary edema, Crackles, 2pillow
Stimulation of vasomotor Regulating centers
decrease perfusion of tissues of the body
Activation of the sympathetic NS
GFR
Renal involvement
Catecolamines (ephinephrine)
proneinuria, Urea (8.0)
Renin secretion
Formation of Angiotensin
Lungs (ACE)
Angiotensin
ADH
Na, and water retention
Osmotic pressure
Osmotic pressure
Pulmonary edema: dypnea, cough Crackles, 2pillow orthopnea HR
Increase pulmonary vascular saturation resistance
O2
RV contraction
Force of RV contraction
RV oxygen demand Peripheral edema, liver congestion Ascities, weakness.
RV
RV force of contraction
residual blood flows from RV
RV
Blood backflows from RV
RA
fluid absorb into the from RA to RV Interstitial space
venous Pressure JVD
Blood backsflow
B. SYNTHESIS OF THE DISEASE (BOOK CENTERED) Congestive heart failure (CHF) is an imbalance in pump function in which the heart fails to adequately maintain the circulation of blood. The most severe manifestation of CHF, pulmonary edema, develops when this imbalance causes an increase in lung fluid secondary to leakage from pulmonary capillaries into the interstitium and alveoli of the lung. CHF can be categorized as forward or backward ventricular failure. Backward failure is secondary to elevated systemic venous pressure, whereas left ventricular failure is secondary to reduced forward flow into the aorta and systemic circulation. Furthermore, heart failure can be subdivided into systolic and diastolic dysfunction. Systolic dysfunction is characterized by a dilated left ventricle with impaired contractility, whereas diastolic dysfunction occurs in a normal or intact left ventricle with impaired ability to relax and receive as well as eject blood. Congestive heart failure (CHF) is summarized best as an imbalance in Starling forces or an imbalance in the degree of end-diastolic fiber stretch proportional to the systolic mechanical work expended in an ensuing contraction. This imbalance may be characterized as a malfunction between the mechanisms that keep the interstitium and alveoli dry and the opposing forces that are responsible for fluid transfer to the interstitium. Maintenance of plasma oncotic pressure (generally about 25 mm Hg) higher than pulmonary capillary pressure (about 7-12 mm Hg), maintenance of connective tissue and cellular barriers relatively impermeable to plasma proteins, and maintenance of an extensive lymphatic system are the mechanisms that keep the interstitium and alveoli dry.
Opposing forces responsible for fluid transfer to the interstitium include pulmonary capillary pressure and plasma oncotic pressure. Under normal circumstances, when fluid is transferred into the lung interstitium with increased lymphatic flow, no increase in interstitial volume occurs. However, when the capacity of lymphatic drainage is exceeded, liquid accumulates in the interstitial spaces surrounding the bronchioles and lung vasculature, thus creating CHF. When increased fluid and pressure cause tracking into the interstitial space around the alveoli and disruption of alveolar membrane junctions, fluid floods the alveoli and leads to pulmonary edema.
9. PATHOPHYSIOLOGY (CLIENT-CENTERED)
a. SCHEMATIC DIAGRAM
Family History of increase BP On uncle, grandfather
Smoking (since teen age) High BP (since age 42)
Family history of HF experienced By grandfather at age of 87
Genetic predisposition
Cell membrane alteration
Vasoconstriction of blood vessels
Increased peripheral
HTN
Vasoconstriction of afterload Coronary arteries
increase
Increase LV contraction Increase pressure of blood flow hypertropy Increase LV
Vessel damage Increase CO Body detects vessel damage Hypoxia
increase clotting factor and accumulation of fats insufficiency LV ventricular
and other blood components increase LV pressure Scarring Atherosclerosis
LV regurgitation to LA
Increase LA pressure
Backflow of blood to the pulmonary
Decrease cardiac tissue Blood flow
decrease brain perfusion: dizziness, light headedness, anxiety, restlessness, decrease Response to energy demand causing
pulmonary edema
Decrease cardiac muscle
Contraction
Decrease CO
Activation of baroreceptors In the LV, Aortic
Decrease systemic Blood pressure
Stimulation of vasomotor Regulating centers
decrease perfusion of tissues of the body
Activation of the sympathetic NS
GFR
Renal involvement
Catecolamines (ephinephrine)
proneinuria, Urea (8.0)
Renin secretion
Formation of
Lungs
Angiotensin
(ACE)
Angiotensin
ADH
Na, and water retention
Osmotic pressure
Osmotic pressure
Pulmonary edema: dypnea, cough Crackles, 2pillow orthopnea HR
Increase pulmonary vascular resistance
O2 saturation
RV contraction
Force of RV contraction
RV oxygen demand Peripheral edema, liver congestion Ascities, weakness.
RV
RV force of contraction
residual blood flows from RV
RV
Blood backflows from RV
RA
fluid absorb into the Interstitial space
venous Pressure JVD
Blood backsflow from RA to RV
B. SYNTHESIS OF THE DISEASE (PATIENT CENTERED) Lub dub has a family history of hypertension first experience by his grandfather followed by his uncle,one of his relatives also had a heart failure at the age of 87. And because of his genetic predisposition his cells are modified for vasoconstriction lub dub also smokes and has hypertension since he was 42 yrs old which further contributed to the vasoconstriction of his blood vessels. And due to vasoconstriction he had increase peripheral pressure that led to hypertension. And with hypertension there will be increase in after load which increases left ventricular contraction that caused hypertrophy. With the inability of the left ventricle to contract properly there will be increase carbon dioxide retained that leads to hypoxia. With hypoxia present there would be left ventricular insufficiency that decreases o2 supply going to the brain which caused the manifestation of dizziness, anxiety, restlessness, and decrease response to stimulus. Going back to left ventricular insufficiency the body will try to compensate by increasing left ventricular pressure because of the high pressure blood will then regurgitate to LA from LV that increases LA pressure because of both left subdivision of the heart having increase pressure there would be backflow of blood to the pulmonary system thus causing pulmonary edema. Hypertension also causes vasoconstriction of coronary arteries thus leading to increase blood flow because of the high pressure in the blood flow, blood vessels would be damaged the body then would detect the damage and will release clotting factors and other blood components as a compensatory mechanism. As the clotting factors accumulate there would be scarring causing narrowing of the vessels, with the vessels narrowed there would be decrease in cardiac tissue blood flow leading to cardiac muscle contraction which contributes to the retention of carbon dioxide to the body that causes decrease perfusion of oxygen.
B.1. Definition of the Disease
Congestive heart failure: Inability of the heart to keep up with the demands on it and, specifically, failure of the heart to pump blood with normal efficiency. When this occurs, the heart is unable to provide adequate blood flow to other organs such as the brain, liver and kidneys. Heart failure may be due to failure of the right or left or both ventricles. The signs and symptoms depend upon which side of the heart is failing. They can include shortness of breath (dyspnea), asthma due to the heart (cardiac asthma), pooling of blood (stasis) in the general body (systemic) circulation or in the liver's (portal) circulation, swelling (edema), blueness or duskiness (cyanosis), and enlargement (hypertrophy) of the heart.
B.2. Predisposing and Precipitating Factors PREDISPOSING FACTORS: It has been known for many years that high blood cholesterol, smoking and high blood pressure are the major risk factors for heart disease. A number of studies in Australia and overseas have calculated 'population attributable fractions' for each major risk factor. It is estimated that: High blood cholesterol accounts for between 30 to 40% of all coronary heart disease deaths High blood pressure accounts for between 20 to 25% of all coronary heart disease deaths Smoking accounts for about 17% of all coronary heart disease deaths (21% in men and 11% in women).
Cigarette smoking Cigarette smoking is one of the major causes of heart and blood vessel disease. Latest estimates are that just over 18,000 Australians die from tobacco-related diseases each year. Cigarette smoking causes many early or premature deaths from cardiovascular disease and cancer.
Tobacco smoke contains thousands of chemicals, many of them poisonous. The three main components of tobacco smoke are nicotine, carbon monoxide and tar. Nicotine makes the heart beat faster and it increases the heart's
demand for oxygen, narrows the blood vessels, reducing the blood supply to tissue cells. Carbon monoxide reduces the oxygen supply carried by the blood to all parts of the body including the heart itself. Tar carries many cancer-causing agents. Twenty cigarettes a day reduces the supply of oxygen to the heart by about 10%
Raised blood cholesterol levels Cholesterol is a white, waxy type of fat found in the tissues and bloodstream of all animals, including humans. Some cholesterol in the blood comes from food, but the body can make all it needs. Most people with high blood cholesterol feel perfectly well. They usually get no warning signs and the only way to find out if their level is high is to have it checked. The main thing that raises the blood cholesterol level, is saturated fat. Saturated fat is found in fatty meat, full cream dairy products, butter, many takeaway and processed foods, and two vegetable fats - palm oil and coconut oil (found in many commercially baked products such as, biscuits, cakes and pastries). Cholesterol in foods can also raise blood cholesterol, but its effect is less than saturated fat. Heredity factors can also affect blood cholesterol levels. Some people will have very high levels of blood cholesterol despite healthy eating and regular exercise. In these cases, medication is given to help reduce blood cholesterol levels. The Heart Foundation recommends that all Australian adults should be aiming for a blood cholesterol level of 5.5mmol/L or less. A blood cholesterol level of 4.5mmol/L or less is recommended for adolescents and younger children.
High blood pressure
Blood pressure is the pressure of the blood in the arteries as it is being pumped around the body by the heart. In some people the pressure stays higher than it should. This is called high blood pressure or hypertension. High blood pressure is one of the most common disorders affecting the heart and blood vessels. About one in seven Australian adults have high blood pressure. If not controlled, high blood pressure can overload the heart and blood vessels and speed up the artery-clogging process, known as atherosclerosis. This can lead to heart attack, stroke, heart failure and kidney failure. For the majority of people, high blood pressure is caused by a combination of hereditary and lifestyle factors. The lifestyle factors include: being overweight or obese; drinking too much alcohol; and an excessive salt intake.
Physical inactivity Lack of exercise is associated with an increased risk of heart disease. People who are inactive are more likely to: have less efficient pumping action of the heart have higher blood fat levels have low levels of calcium, which in older people may increase the risk of bone fracture have sleeping problems have a tendency to be overweight have higher blood pressure.
Regular exercise keeps us fit and healthy. Regular physical activity, such as walking, cycling, in-line skating, swimming or mowing the lawn tends to improve risk factors for cardiovascular disease. In particular, regular exercise can have a positive impact on the risk factors: blood cholesterol, blood pressure and overweight. Of course physical activity is also a great way to get out, have fun, meet people and make friends.
The Heart Foundation recommends that all Australian adults enjoy 30 minutes of moderate physical activity every day. Even two 15-minute walks a day can improve heart health.
Overweight and Obesity Too much body fat overloads many parts of the body including the heart and lungs. Fat is living tissue and demands its own supply of oxygen. It has been calculated that for every 14kg of excess weight, there are 40 kilometres of extra blood vessels through which blood must be pumped. Being overweight increases the risk of developing health problems, such as high blood pressure and high blood cholesterol levels. Being overweight is also associated with other serious diseases such as diabetes. The keys to achieving and maintaining a healthy body weight is regular physical activity and healthy eating.
PRECIPITATING FACTORS
Family history People with a history of heart disease in their families tend to be more likely to develop cardiovascular disease. The risk of heart disease is greatly increased if a parent in a family dies from heart or blood vessel disease before the age of 60. For people in these families particular attention needs to be given to risk factors that are modifiable.
Sex and age A large increase in death rates from heart disease is seen with increasing age in both men and women. Up to the age of 50, the death rate in men is higher than in women. In later years, the difference is smaller, with the rates for men and women being the same in the later years of life.
The differences in death rates for men and women are thought to be hormone related. Some female hormones are thought to protect against heart disease until the menopause. B.3. Signs and Symptoms with Rationale Chest pain-because of the left ventricular hypertrophy and the damage of the coronary blood vessels, the body releases substances to compensate for the damages thus affecting nosi receptors causing pain. Vomitting- because of the imbalance in the CO-O2 mechanism the body compensates by decreasing HCL in the stomach thus leading to prevention of metabolic acidosis. DOB- the patient also manifested DOB secondary to BAIAE. The pt had asthma attack on the attempt of the body to regulate the excess CO. Crackles on both lung fields- backflow of blood in the pulmonary circulation causes accumulation of fluid on the lungs leading to crackles. Edema- HTN elicited by the client caused shift of fluids in the interstitial spaces that resulted to edema. Fatigue- because of the decrease oxygen supply, the body is not able to work properly and signals the brain of fatigue to limit activity. Productive cough- was manifested secondary to BAIAE resulted from 7 mucus production because of foreign invasion.
B.4. Health Promotion and Preventive aspects of the disease Treating BAIAE Although the treatment for pneumonia depends on the cause of the condition, some simple steps can help speed recovery from BAIAE:
Avoid eating too much salt and salty foods (like canned vegetables or soups, chips and pizza). Salty and high-sodium foods can cause your body to retain water. Talk to your doctor before using salt substitutes because they often contain potassium and may not be good for your health either. This will depend on your kidney function and what medicines you are taking. Some people need extra potassium but other people dont. Although drinking a small amount of alcohol (one drink a day) seems to be helpful in some people with heart disease, drinking too much may cause heart failure and interfere with medicines. Ask your doctor if any amount of alcohol is safe for you. Keep your blood pressure well controlled. High blood pressure strains your heart and further weakens it. Youll be healthier if you exercise. Ask your doctor to recommend an exercise program for you. Try to reduce the stress in your life and get plenty of sleep. If you smoke, quit! If you are overweight, talk to your doctor about how to lose weight safely. Also talk to your doctor before you take any medicine. Common arthritis medicines like naproxen (one brand name: Aleve) and ibuprofen (one brand name: Advil) can cause fluid retention. Fluid retention and weight gain are one signal that your CHF may not be in good control. Weigh yourself daily at the same time of day and report any unexplained changes to your doctor
Personal methods to avoid BAIAE

Prevent pneumonia by taking measures to avoid the organisms that cause respiratory infections, including colds and flu. Always wash hands before eating and after going outside. Ordinary soap is okay. Expensive antibacterial soaps add little protection, particularly against viruses.
1. Eat a daily diet that includes foods rich in antioxidants, such as fresh, darkcolored fruits and vegetables and other nutrients. 2. Increase lung capacity through brisk walking and other aerobic exercises. Breathing exercises, which train us to take slow, deep, relaxed breaths and exhale through pursed lips, may also be helpful. 3. Do not smoke.
http://www.nevdgp.org.au/info/heartf/school/risk.htm http://emedicine.medscape.com/article/757999-overview http://www.scribd.com/doc/13409915/Pathophysiology-Diagram-of-CongestiveHeart-Failure
I.
THE PATIENTS ILLNESS
V. PATIENT AND HIS CARE A. MEDICAL MANAGEMENT a. IVFs, BT, NGT feeding, Nebulization, TPN, Oxygen therapy, etc.
MEDICAL MANAGEMENT/TREAT MENT DATE ORDERED GENERAL DESCRIPTIO N INCATIONS/PURPO SES CLIENTS RESPONSE TO TREATMEN T
PNSS
08-08-10 08-09-10
Normal saline solution is a solution of common an aqueous solution of 0.9 percent sodium chloride, isotonic with the blood and tissue fluid, used in medicine chiefly for bathing tissue and, in sterile form, as a solvent for drugs that are to be administered parenterally to replace body fluids.
NS can be used to replace fluids in dehydration, go with blood transfusions, hyponatremia, and burn victims, it is isotonic,( same osmolarity as our body fluids. Not noted.
Nursing responsibilities Prior Check the doctors order
During
Check the expiration date of the IVF Inform the patient about IVF to be given Explain the procedure to the patient or the patients significant other
Prepare the materials Wash your hands thoroughly Identify the right client Find a site for insertion Hold the patients hand firmly Clean the site of insertion Instruct the patient to breathe deeply if insertion is to be started Secure the tube, and cover the entry site and external portion of the tube with an occlusive dressing.
After After the insertion, regulate the IVF Document the procedure done Assess the site for any redness, swelling or drainage Ensure appropriate infusion flow Monitor IV infusion at least every hour, more frequent check may be necessary if medication is being infused.
MEDICAL MANAGEMENT/TREAT MENT
DATE ORDERE D
GENERAL DESCRIPTI ON
INCATIONS/PURPO SES
CLIENTS RESPONSE TO TREATMENT
Nebulization
08-08-10 08-09-10
Used to administer medication in the form of a mist inhaled into
A nebulizer makes inhaling medication easier for people who are having serious difficulty breathing
There were no untoward reactions noted. Though, there were
the lungs.
or who have trouble using an inhaler, which requires careful timing and control of one's breathing.
signs of shortness of breathing and increase respiratory rate.
080808 The patient was not relieved from shortness of breathing. Furthermore , nebulization was ordered and administered from patients admission up to discharge.
Nursing responsibilities Prior Read the physicians order regarding the amount and frequency of the nebulization
Explain the need for nebulization and the procedure to the patients significant other Assemble equipment needed Identify clients mane
During After Set the nebulizer off After the nebulization, provide postural drainage to loosen the secretions if not contraindicated Encourage the patient to have an oral hygiene to minimize dryness of mouth. Place the nebulizer at the bedside Prepare the medications Place the medication on the nebulizer kit Set the nebulizer on Place the nebulizer at near of the nose of the nose or mouth
MEDICAL MANAGEMENT/TREATM ENT
DATE ORDERE D
GENERAL DESCRIPTIO N
INCATIONS/PURPOSE S
CLIENTS RESPONSE TO TREATMENT
Oxygen therapy
08-0810 08-0910
Oxygen therapy is the administrati on of oxygen at concentrati ons greater than that in room air to treat or
The body is constantly taking in oxygen and releasing carbon dioxide. If this process is inadequate, oxygen levels in the blood decrease and the patient may need supplemental oxygen. Oxygen therapy is a
The patient did not maintain balanced gas exchanged and there are signs of shortness of breathing and
prevent hypoxemia (not enough oxygen in the blood). Oxygen delivery systems are classified as stationary, portable, or ambulatory. Oxygen can be administere d by nasal cannula, mask, and tent. Hyperbaric oxygen therapy involves placing the patient in an airtight chamber with oxygen under pressure.
key treatment in respiratory care. The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury. Breathing prescribed oxygen increases the amount of oxygen in the blood, reduces the extra work of the heart, and decreases shortness of breath. Oxygen therapy is frequently ordered in the home care setting, as well as in acute (urgent) care facilities. Some of the conditions oxygen therapy is used to treat include: documented hypoxemia severe respiratory distress (e.g., acute asthma or pneumonia) severe trauma
increase in respiratory rate
080808 The patient was not relieved from shortness of breathing. Furthermor e, oxygen therapy was administere d from patients admission up to discharge.
Nursing responsibilities Prior Inform the patient before the procedure Explain to the client the importance and use of such treatment Tell the client that he will not feel any pain upon administration
During After Put no smoking sign at the room because oxygen is highly combustible Check frequently if it is regulated properly and if the tubing is not occluded Document the procedure. b. Drugs
NAME OF DRUGS; GENERIC NAME BRAND NAME DATE ORDERED ROUTE, DOSAGE, FREQUENC Y GENERAL ACTION INDICATIONS/PURP OSES CLIENTS RESPONSE TO THE MEDICATION WITH ACTUAL SIDE EFFECTS
Put the tubing where the patient is most comfortable Make sure that the air delivered to the patient is humidified Set the flow rate as prescribed Assess the patient and inspect the equipment regularly
Generic Name: citicholine sodium Brand
08-08-10 08-09-10
(R) oral (D) 1 gm (F) q 8 hrs.
Citicholine increases blood flow and O2 consumptio n in the
Citicholine is indicated in CVD in acute recovery phase in severe s/sx of cerebrovascular
The patient was able to response with the medication
Name: Zynapse, Somazine, Cholinerve
brain. It is also involved in the biosysntehsi s action.
insufficiency and in-cranial traumatism and their sequellae. Citicholine in CVA, stimulates brain function.
AEB
Nursing responsibilities Take Citicholine as prescribed Take Citicholine on time Monitor patients neurologic status Note if there are signs of slurring of speech Note for adverse reactions Titer medication when discontinuing Teach patient on how to take the drug Arrange for regular follow-ups
NAME OF DRUGS; GENERIC NAME BRAND NAME
DATE ORDERED
ROUTE, DOSAGE, FREQUENC Y
GENERAL ACTION
CLIENTS RESPONSE TO THE MEDICATIO N WITH ACTUAL SIDE EFFECTS
GENERIC NAME:
08-08-10 08-09-10
(R) oral (D) 40mg/tab (F) OD
Furosemide is a potent diuretic (water pill) that is used
Furosemide is a powerful diuretic that is used to treat excessive accumulation of
The patient responded well as evidence
furosemide BRAND NAME:
Lasix
(am)
to eliminate water and salt from the body. In the kidneys, salt sodium and chloride), water, and other small molecules normally are filtered out of the blood and into the tubules of the kidney. The filtered fluid ultimately becomes urine. Most of the sodium, chloride and water that is filtered out of the blood is reabsorbed into the blood before the filtered fluid becomes
fluid and/or swelling (edema) of the body caused by heart failure, cirrhosis, failure, and the nephrotic syndrome. It is sometimes used alone or in conjunction with other blood pressure pills to treat high blood pressure.
by a decrease in the blood pressure from 150/100 mmhg to 110/90 mmhg though the patient edema, bilateral rales were not reduced.
(composed of chronic kidney
urine and is eliminated from the body. Furosemide works by blocking the absorption of sodium, chloride, and water from the filtered fluid in the kidney tubules, causing a profound increase in the output of urine (diuresis). The onset of action after oral administratio n is within one hour, and the diuresis lasts about 6-8 hours. The onset of action after injection is
five minutes and the duration of diuresis is two hours. The diuretic effect of furosemide can cause depletion of sodium, chloride, body water and other minerals.
Nursing responsibilities Prior Assess the status during therapy, monitor daily weight, intake, and output ratio, amount and location of the edema, lung sounds, skin turgor and mucous membranes. Notify physician or other health care professional if thirst, dry mouth, lethargy, weakness, hypertension or oliguria occurs. Monitor blood pressure and pulse before and during the administration.
During After check the doctors order before giving the medication explain the purpose of the drug administer the medication in the morning to prevent disruption of sleep cycle do not administer discolored solution.
caution patient to change position slowly to minimize orthostatic hypertension Advise the patient to contact health care professional before taking OTC medications or herbal products concurrently with this therapy. Caution the patient to use sunscreen and photosensitivity reaction. Advise the patient to contact health care professional immediately if muscle weakness, cramps, nausea, dizziness, numbness or tingling of extremities occurs.
Reinforce the need to continue additional therapies for hypertension (weight loss and exercise).
DATE ORDERED
GENERAL ACTION
Imdur
08-08-10 08-09-10
(R) oral (D) 30mg/tab (F) OD (hs)
Imdur is in a group of drugs called nitrates. Isosorbide mononitrat e dilates (widens) blood vessels, making it easier for blood to flow through
Imdur is used to prevent angina attacks (chest pain).
Not noted.
Generic Name: isosorbide mononitrat e
Brand Names: Imdur, ISMO, Monoket
them and easier for the heart to pump.
Nursing responsibilities Instruct patient to take medication as directed, even if feeling better. Take missed doses as soon as remembered; doses of isosorbide dinitrate should be taken at least 2 hr apart (6 hr with extended-release preparations); daily doses of isosorbide mononitrate should be taken 7 hr apart. Do not double doses. Do not discontinue abruptly Caution patient to make position changes slowly to minimize orthostatic hypotension May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known Instruct patient to take last dose of day (when taking 24 doses/day) no later than 7 pm to prevent the development of tolerance Advise patient to avoid concurrent use of alcohol with this medication. Patient should also consult health care professional before taking Rx, OTC, or herbal products while taking isosorbide Inform patient that headache is a common side effect that should decrease with continuing therapy. Aspirin or acetaminophen may be ordered to treat headache. Notify health care professional if headache is persistent or severe. Do not alter dose to avoid headache Advise patient to notify health care professional if dry mouth or blurred vision occurs
DATE ORDERED
GENERAL ACTION
salmeflo
08-08-10 08-09-10
(R) (D) 250mg 1 puff (F) BID
Antiasathmati c and COPD preparations
Treatment of reversible obstructive airways disease including asthma; management of COPD like chronic bronchitis & emphysema.
Not noted
Nursing responsibilities
DATE ORDERED
ROUTE, DOSAGE, FREQUENCY
GENERAL ACTION
CLIENTS RESPONSE TO THE MEDICATION WITH ACTUAL SIDE EFFECTS
becrephine
08-08-10 08-09-10
(R) IV (D) 1gm/vial (F) q 12
Not noted
DATE ORDERE D
GENERAL ACTION
Vivelon
08-0810
(R) oral (D) 45mg/tab (F) OD
Anticoagulants , Antiplatelets & Fibrinolytics (Thrombolytics )
Given prophylactically as an alternative to aspirin in patients at risk of thromboembolic disorders eg MI, peripheral arterial disease & stroke.
Not noted
clopidrogre l
08-0910
Nursing responsibilities Check the doctors order. Provide frequent small meals if GI upset occurs. Provide comfort measures and arrange for analgesics if headache occurs. Document after the administration.
DATE ORDERE D
ROUTE, DOSAGE, FREQUEN CY
GENERAL ACTION
Duavent
08-0810
(R) (D) (F)
Anticholinergi c Antimuscarini c Bronchodilato r
Bronchodilator for maintenance treatment of bronchospasm associated with COPD, chronic bronchitis, and emphysema.
The patient showed relief from difficulty of breathing though presence of rales may still auscultated. The patient still experienced shortness of breathing and increase in respiratory rate. Furthermore , the medication was ordered and administere d up to patients discharge.
Ipratropiu m bromide
08-0910
Nursing responsibilities Prior
Check the written medication order for completeness. It should include the drug name, dosage, frequency and duration of the therapy. Check to see if there are any special circumstances surrounding administration of the dose to the patient. Be certain that you know the expected action, safe dosage range, special instruction for administration and adverse effects associated with drug order. Decrease dosage in patient with impaired renal function. Check the label on the medications 3 times before administering any drug. Never prepare a dosage of medication which is discolored, has precipitated and is contaminated or outdated. Identify the patient/so expresses any doubt about the medication; always check the order, drug label and dosage on the container. Following administration, be certain that the patient is comfortable, then immediately record the procedure.
DATE ORDERED
GENERAL ACTION
Zyom
08-08-10 08-09-10
(R) oral (D) 40mg/tab (F) BID
Antisecretor y drug Proton pump inhibitor
Treatment of duodenal ulcer, gastric ulcer and reflux esophagitis. Also used for the control of acid secretion in pathological hypersecretory condition e.g. Zollinger-Ellison Syndrome.
Not noted
Generic Name: Omeprazole
Nursing responsibilities Check the doctors order. Administer before meals. Caution patient to swallow capsule wholenot to open, chew or crush them. If using oral suspension, empty packet into a small cup containing 2 tbsp of water. Stir and have patient drink immediately; fill the cup with water and have patient drink this water. Do not use any other diluents. If patient cannot swallow capsules, contents of capsules may be added to or sprinkled on 1 tbsp applesauce and have patient swallow immediately without chewing pellets. Follow with glass of water. Document after the administration.
DATE ORDERED ROUTE, DOSAGE , FREQUE NCY GENERAL ACTION INDICATIONS/PURPOS ES CLIENTS RESPONSE TO THE MEDICATION WITH ACTUAL SIDE EFFECTS
Holdestin e
08-08-10 08-09-10
(R) oral (D) 500mg/ tab
Ciprofloxacin is a synthetic chemotherapeut ic antibiotic from the fluoroquinolone
Ciprofloxacin is used in the treatment of chronic bacterial prostatitis. It is also used in the treatment of skin or skin structure, GI tract, bone or joint, lower respiratory tract, and urinary tract infections. Ciprofloxacin is also
Not noted
(F) BID drug class
used in the treatment of chancroid. Ciprofloxacin is also used in the treatment of infectious diarrhea, uncomplicated gonorrhea, empiric treatment of febrile neutropenia, and acute sinusitis. It can also be used for conjunctival keratitis, keratoconjunctivitis, corneal ulcers, blepharitis, dacrocystitis, blepharoconjunctivit is, and acute meibomianitis.
Nursing responsibilities Question for history of hypersensitivity to Ciprofloxacin or Quinolones. May be given without regards to meals. Preferred dosing time 2 hours after meals. Do not administer antacids within 2 hours of Ciprofloxacin. Encourage cranberry juice or citrus fruits. Evaluate food tolerance.
Determine pattern of bowel activity. Check for dizziness, headache, visual difficulties, and tremors. Observe therapeutic response.
DATE ORDERE D
ROUT E, DOSA GE, FREQ UENC Y
GENERAL ACTION
INDICATIONS/P URPOSES
Ectin
08-0810 08-09-
(R) oral (D) 200m g/tab (F) BID
Respiratory/ Cough & Cold Preparations/ Mucokinetics/Expe ctorants
Treatment of acute & chronic bronchitis, & its exacerbation s; resp disorders characterized by abnormal bronchial secretions, & impaired mucus transport.
Not noted
Generic Name: Erdostein e
10
NAME OF DRUGS; GENERIC NAME
DATE ORDERED
ROUTE, DOSAGE, FREQUENCY
GENERAL ACTION
CLIENTS RESPONSE TO THE MEDICATION
BRAND NAME
WITH ACTUAL SIDE EFFECTS
Restor F
08-08-10 08-09-10
(R) (D) (F) OD
Not noted
C. diet
TYPE OF DIET DATE ORDERE D DATE STARTED DATE CHANGE D GENERAL DESCRIPTI ON INDICATIONS/PURP OSES SPECIFI C FOODS TAKEN CLIENTS RESPONSE/REACT ION TO THE DIET
NPO
NPO stands for Nothing Per Orem which means nothing by mouth. Doctors use this on orders when they do not want the patient to take in any type of food or liquid by mouth. For instance, when a patient is getting ready for a surgery, they are ordered for NPO.
Restriction of neither solid nor liquid foods by mouth.
none
Not noted.
Date started: 08-08-10
Date change: 08-09-10
TYPE OF DIET
DATE ORDERE D DATE
GENERAL DESCRIPTIO N
INDICATIONS/PUR POSES
SPECIF IC FOODS TAKEN
CLIENTS RESPONSE/REACT ION TO THE DIET
STARTED DATE CHANGE D
Soft diet
A soft diet is recommend ed in many situations, including some types of dysphagia (difficulty swallowing), surgery involving the jaw, mouth or gastrointesti nal tract, and pain from newly adjusted dental braces.
Not noted.
C. NURSING MANAGEMENT 1. Nursing Care Plan Ineffective airway clearance
Assessment S> O> Tachycardia >Nasal flaring >presence of rales on BLF >Use of accessory >pallor >productive cough >restlessness >irritability May manifest: >dyspnea
Nursing Diagnosis Ineffective airway clearance r/t thick bronchial secretions/ pulmonary congestion secondary to CHF.
Scientific Explanation The underlying pathology is asthma is reversible and diffuse airway inflammation. The inflammation leads to the obstruction from the swelling of the membranes that line the airways (mucosal edema),
Planning Short term: After 4 to 5hrs of NI, the pt will demonstrate reduction of congestion with breath sounds clear, respirations noiseless, improved oxygen exchange.
Intervention Assessed and monitored respiratory rate, depth, and rhythm. Auscultated chest noted presence of adventitious breath sounds and presence of secretions.
Rationale Changes may indicate progression of respiratory compromise Checks inflow through the airway and the presence or absence of fluid mucus obstruction.
Evaluation Short term: After 4 to 5hrs of NI, the pt shall have demonstrate reduction of congestion with breath sounds clear, respirations noiseless, improved oxygen
Prevents stasis exchange. Encouraged prone and of secretions and promotes
>orthopnea >difficulty vocalizing >cyanosis
reducing the airway diameter; contraction of the bronchial smooth muscle that encircles the airways (bronchospas m), causing further narrowing; and increased mucus production, which diminishes airway size and may entirely plug the bronchi. The bronchial muscles and Long term: After 2days of NI, the patient will be able to maintain a patent airway.
upright positioning especially when feeding
lung expansion.
To loosen Encouraged to increase fluid intake Promotes SOs Imparted health teachings such as importance of positioning Enhances Ensure medication administration as ordered. Nebulized with Salbutamol as ordered. Perform chest clearance of secretions from airway. understanding and participation and care secretions. Long term: After 2days of NI, the pt shall have able to maintain a patent airway.
mucus glands enlarge; thick tenacious sputum is produced; and the alveoili hyperinflate.
physiotherapy after treatment
Impaired Gas Exchange
Assessment
Nursing Diagnosis
Scientific Explanation
Planning
Intervention
Rationale
Evaluation
S= O= the patient manifested: -tachypnea
Ineffective breathing patterns r/t improper gas exchange
Fluid filled alveolar sack cannot exchange O2 & CO2 effectively. Alveolar exudate tends to consolidate, so it is difficult to expectorate. This accumulation of
Short term:
> establish rapport
> to allay anxiety
Short term:
> After 4 hours of NI, patient will verbalize understanding of causative factors &
> monitor & record v/s
> for baseline data
After 4 hours of NI, patient was able to verbalized
The patient may manifest:
> auscultate breath sounds
> Ascertain status & note
understanding of causative factors
> productive cough > nasal discharges > diminish or adventitious breath sound (rales) > restlessness
secretions leads to a more narrowed airway resulting to impaired gas exchange.
appropriate Interventions. > elevate HOB/ change position every 2 hours & wheneve rnecessary.
progress.
& appropriate interventions.
> To enhance drainage of ventilation to different lung segments.
>encourage to oral fluid intake
> to help liquefy secretions
Long term: > After 4 to 5 days of NI, patient will be able to maintain proper gas exchange. > provide nebulization as ordered > Observe for signs of respiratory distress
> To assess changes & note complications
Long term: > After 4-5 days of NI, patient was able to maintain proper
>to loosen secretions
gas exchange.
>to mobilize > perform bronchial tapping > To provide > Administer drug as order pharmacologic treatment. secretions
Ineffective Breathing Pattern
Cues
Nursing Diagnosis
Scientific Explanation
Objectives
Nursing Interventions
Rationale
Outcome
S> O> The patient manifested the following: - Irritability
> Ineffective Breathing Pattern related to presence of tracheo-bronchial secretions and nasal secretions
Alteration on the clients O2:CO2 ratio due to decreased absorbed oxygen and poor gas exchange related to presence to exudates on the
Short Term:
>Establish rapport
>To gain trust and cooperation
Short Term:
After 3 hours of nursing intervention, the patient will be able to verbalize understanding of >Assess and record VS >To have baseline data
After 3 hours of nursing interventions, the patient shall verbalize
-tachycardia -Nasal secretion -productive cough -use of accessory muscle -wheezes on both lungs upon auscultation.
alveolar spaces causes the body to cope by increasing respiratory rate
technique to facilitate proper oxygenation to alleviate hyperventilation
>Assess patients general condition
>To identify plans of nursing care
understanding of technique to facilitate proper oxygenation to
> Instruct patient to increase oral fluid intake to 8-10 glasses
> Increased mucus and sputum secretions can lead to dehydration; helps dissolve secretions
alleviate hyperventilation.
or by hyperventilation. The increase in respiratory rate is elicited to cause an increase in the tidal volume of air that in inspired in order to absorb more oxygen. The increase in respiratory rate may need the assistance of accessory muscle that would be evident After 3 days of nursing intervention, patient will be free from tachycardia and establish normal breathing pattern. Long Term:
>Presence may trigger allergic >Keep environment allergen free (dust, feather pillows, smoke, pollen) response that may cause further increase in mucus secretion After 3 days of nursing interventions, the >Assess feeding intolerance, abdominal distension and emotional stress >These may compromise airway. A distended abdomen can interfere with normal patient shall be free from tachycardia and establish normal breathing pattern. Long Term:
The patient may manifest the following:
- dyspnea -fatigue - altered chest excursion - nasal flaring - increased anterior-posterior diameter >Suction nasotracheal/ oral PRN by the rising and falling of the shoulders during inspiration and expiration.
diaphragm expansion that facilitates air exchange.
>To clear secretions blocking the airway.
>To enable the body to recuperate
>Encourage patient to rest
>To prevent infections such as nosocomial infections
>Educate proper hand washing >To facilitate proper chest expansion
>To determine >Position the patient in semi fowlers position extent of affected areas and need for other treatments
>Review clients chest x-ray for severity conditions
Activity Intolerance Assessment Nursing Diagnosis Scientific Explanation Planning Intervention Rationale Evaluation
S=
Activity
There
is
an Short term:
> establish rapport
> to allay anxiety
Short term:
O= the patient manifested: -improper gas exchange -body malaise
intolerance r/t O2 levels for
inflammation to the
in >After 3 hours of NI, patient defense will be able to perform motor skills appropriately.
> monitor & record v/s > auscultate breath sounds
> for baseline data > Ascertain status & note progress. After 3 hours of NI, patient was able to perform motor skills appropriate for his age. > To promote comfort for the patient.
pulmonary response
offending organism. metabolic demands The mechanism of lungs loses effectiveness & allows organism to penetrate the sterile lower tract where inflammation develops. Disruption of the mechanical defenses of cough & ciliarys motility leads to colonization of
the patient may manifest:
> stretch bed linens & clear environment
>unproductive cough > restlessness > weakness > nasal flaring
>encourage to increase oral fluid intake
>for tissue perfusion; support circulating vol.
lungs & subsequent infection. to Depleted of Long term: energy reserves due impairment & little > Observe for signs of respiratory distress
> To assess changes & note complications Long term: > After 3 days of
oxygen dioxide leave meet to
carbon transport O2
to > After 3 days
metabolic of NI, patient activity perform motor > provide >to loosen secretions
demands w/c leads will be able to
NI, patient was able to perform
Decrease cardiac output Assessme nt Nursing diagnosis Scientific Explanation Objective s Nursing interventions Rationale Expected outcome
S> O> shortness of breath >Anxiety >Fatigue >producti ve cough >edema >restless ness May manifest: >orthopn ea >palpitati ons >tachyca rdia >cold >pallor
Decrease cardiac output related to altered myocardial contractility/ino tropic changes.
Heart failure also called congestive heart failure occurs when cardiac ouput is inadequate to meet the metabolic demands of the body. The heart rate increases as a compensat ory mechanism to increase cardiac output, and vasoconstri ction occurs to try to maintain blood pressure. Eventually, the chronic increase in preload and
After 8 hrs of nursing intervent ions the patient will display vital signs within the acceptab le limits, dysrhyth mias controlle d and no symptom s of failure.
Auscultate apical pulse; assess heart rate, and rhythm
Tachycardia usually present even at rest to compensate for decrease ventricular contractility. Pallor is an indicative of diminish peripheral perfussion secondary to inadequate cardiac output,vasocons triction,and anemia. Cyanosis may develop in refractory heart failure. Dependent areas are often blue or mottled as venous congestion increases. Urine output os usually decrease during the day because of fluid shifts into the tissues
Inspect skin for pallor, cyanosis.
After 8 hrs of nursing intrventi on the patient was able to display VS within acceptab le limits, dysrhyth mias controlle d and no symptom s of failure.
afterload contribute to chamber dilation and hypertroph y, worsening heart failure. Underlying causes of heart failure include congenital heart disease, rheumatic heart disease, endocarditi s, myocarditis and non cardiovascu lar causes such as, chronic pulmonary edema, pulmonary emboli, refractory heart failure and myocardial
Monitor urine output , noting decreasing output and dark of concentrated urine.
but may be increase at night because fluid returns to circulation when patient is recumbent. May indicate inadequate cerebral perfusion secondary to decrease cardiac output. Psychological rest help reduce emotional stress , which can produce vasoconstriction , elevating BP and increasing heart rate or work.
Note changes in sensorium.
Provide quiet environment.
Increases available oxygen for myocardial uptake to combat effects of hypoxia or
failure.
ischemia. Diuretics, in conjunction with restriction of dietary sodium and fluids, often lead to clinical improvement in patient with heart Failure.
Dependent Administer supplement al oxygen as indicate d. Administer diuretics as prescribed.
2. Actual SOAPIERs 08-08-10 ER notes Admitted a 58 yrs old, male patient with chief complaint of DOB Consent for admission signed and served Examine by Dr. castro with doctors made and carried out: Initial VS taken and recorded NPO temp instructed Inserted # 1 PNSS 1L x KVO CBC, RBS and Crea requested Na and K+ -- done Chest PA x-ray --- done ECGdone Liner profile requested Meds given O2 inhalation via nasal cannula @ 1-2 cpm Informed Dr. Nicolas via text Needs attented Endorsed 08-08-10 Received patient from the ER with an IVF # 1 PNSS 1L x KVO @ full level VS taken and recorded Conscious and coherent (+) mild DOB, (-) chest Pain With o2 inhalation @ 1-2 lpm via nasal cannula CBC, RBS, lipid profile Crea Na, K in relayed to dra. Castro 12 LECG in CXR PAdone On NPO temp.
Attended For continuing of meds 08-08-10 Received patient with ongoing IVF # 1 PNSS 1L x KVO @ 600cc level Afebrile, (-) chest pain Conscious and coherent With 02 inhalation via nasal cannula @ 1-2 lpm Still for CBC, RBSrequested as endorsed NPO temp Vs taken and recorded Due meds given Provided comfort and safety measures Needs attended Endorsed 08-09-10 Received patient on bed with ongoing IVF # 1 PNSS 1L x KVO @ 400 cc level Conscious and coherent Without DOB, afebrile With o2 inhalation via nasal cannula @ 1-2 lpm NPO temp Vs taken and recorded Due meds given Seen on rounds by Dr. castro with ordrs made and carried out: Salbutamol neb, 1 neb q 20 CPT after neb Still for NPO Ranitidine, amp. q 8 Furosemide 40 mg/tab OD in Am-- P Imdur 30mg/tab OD at HS-- P Salmeflo 250mg 1 puff Bid-- P d/c ranitidine
Seen on rounds by Dr. Nicolas with orders made and carried out:
becrephine 1 gm IV q 12--P vivelon 75mg/tab OD--P d/c salbutamol duavent neb q 6--P zyom 20mg/tab OD Bid--P for 2D echo-- R holdestin 500mg Bid-- P ectin 300mg Bid-- P restor F OD may have soft diet instructed
VI.
CLIENTS DAILY PROGRESS IN THE HOSPITAL August 8, 2010 August 9, 2010
Nursing Diagnosis
Decreased Cardiac Output r/t inability of the heart to pump blood effectively Impaired Gas Exchange r/t accumulation of fluid in the alveoli Ineffective airway clearance
Ineffective breathing pattern
Activity intolerance
Vital Signs Temperature 36.5 36
Pulse Rate Respiratory Rate
100 32
92 32
DISCHARGE PLANNING August 9, 2010
Doctor saw the patient on rounds with orders made and carried out:
Home medication as follows: > furomeside 40mg/tab OD in ampule >Imdor 30mg/tab OD at Hs >Salmeflo 250mg 1 puff BID > D/C ranitidine > Becrephine 1gm IV every 12 hours > Vivelon 75mg/tab OD > D/C salbutamol >Duavent neb every 6 hours >Zyom 20mg/tab BID >For 2d echo >Holdestin 5oomg BID >Ectin 300mg BID >Rector OD >May have soft diet as instructed
M > furomeside 40mg/tab OD in ampule >Imdor 30mg/tab OD at Hs >Salmeflo 250mg 1 puff BID > D/C ranitidine > Becrephine 1gm IV every 12 hours > Vivelon 75mg/tab OD > D/C salbutamol
>Duavent neb every 6 hours >Zyom 20mg/tab BID >For 2d echo >Holdestin 5oomg BID >Ectin 300mg BID >Rector OD
E> T > Minimize exposure to pollutants; smoking H> Limit Fatty foods O> D > May have soft diet as instructed
Summary Heart failure, or congestive heart failure (CHF), is a very common disease, afflicting approximately 5 million Americans. While many other forms of heart disease have become less common in recent years, CHF has been increasing steadily. This may be because more people with other forms of heart disease survive longer but are left with damaged hearts, which leads to CHF. Also, as the elderly population increases, there are more people at high risk of developing CHF. Approximately 500,000 new CHF cases occur each year, and it is the most common diagnosis in hospital patients over 65. The purpose of the heart is to pump blood, which contains oxygen and nutrients, to the rest of the body. CHF is simply the
failure of the heart to perform this main function adequately. Of course, a lack of blood pumped to the body is only considered CHF if the heart actually receives a sufficient volume of blood from the incoming vessels in the first place (i.e., normal filling pressures). When there is not enough blood for the heart to pump out, the problem is not CHF. Symptoms of heart failure are Fainting Persistent Chest pain (Serious) Feeling faint, light headed or dizzy may be due to a reduction of blood flow to the brain. Pain due to heart problems is usually felt in the chest, but anywhere between the upper abdomen (upper trunk) and throat, including the arms or shoulders. Frequent awakenings due to shortness of breath Breathless lying down because the fluid in your lungs (congestion) moves with gravity, making more of your lungs wet Rapid heart rate or worsening palpitations Palpitations indicate an irregular heart beat caused by the heart speeding up to compensate for its failing ability to pump blood normally. Worsening cough The Diagnostic procedures that can be perform when there is an occurrence of CHF are the following: Echocardiogram, CXR, ECG, Atrial Natriuretic Factor, BNP, Arterial Blood Gas, Liver Function Test, Urinalysis, BUN, Creatinine, Serum Na, K, Cl, Central Venous Pressure Monitoring and Pulmonary Artery Pressure Monitoring. For the Pharmacologic management, Inotropic medications are given to facilitate myocardial contractility and enhance stroke volume and these are Digoxin, Dopamine, Dobutamine. Another, ACE inhibitors are given to promote vasodilation. Beta Blockers are given to improve the symptoms, increase exercise tolerance. Diuretics are given to control fluid volum. Vasodilators are used to decrease workload by reducing pre-load and afterload. Anti-dysrhythmic drugs are also given. Another medical management is Oxygen therapy, Diet which is sodium restricted diet. For activity, they should be at bed rest- moderate progressive activity program. Elevate HOB in high fowlers position, legs are maintained in a dependent position as much as possible. For surgical management Heart Transplant is used to replace the failing heart. Another, Left Ventricular Remodelling involves cutting a wedge about the size of a pie out of the left ventricle of an enlarged heart and Rapid weight gain Progressive swelling or pain in the abdomen Increased swelling of the legs or ankles Loss of appetite/nausea Increasing fatigue
lastly, Ventricular Assist Device is a mechanical circulatory support to decompress the hypokinetic ventricle.
Conclusion
Congestive Heart Failure (CHF) is the inability of the heart to pump oxygenated blood to different muscles, tissues and organs due to weakening of hearts muscles leading to retention of oxygenated blood in the lower chamber of the heart (left ventricle) and lungs. If experiencing signs of CHF like Fainting Persistent Chest pain (Serious) Feeling faint, light headed or dizzy may be due to a reduction of blood flow to the brain. Pain due to heart problems is usually felt in the
chest, but anywhere between the upper abdomen (upper trunk) and throat, including the arms or shoulders. Frequent awakenings due to shortness of breath Breathless lying down because the fluid in your lungs (congestion) moves with gravity, making more of your lungs wet Rapid heart rate or worsening palpitations Palpitations indicate an irregular heart beat caused by the heart speeding up to compensate for its failing ability to pump blood normally. Rapid weight gain Progressive swelling or pain in the abdomen Increased swelling of the legs or ankles Loss of appetite/nausea Increasing fatigue Worsening cough consult to your physician immediately. Treatment options are the most common forms of heart failure that cannot be cured, but can be treated by lifestyle changes example of these are: stop smoking, loose weight, avoid alcohol or limit caffeine, eat a low-fat, low sodium diet, and exercise medications. Surgery is not often used in heart failure unless there is a correctable problem.
Recommendation For the DOH, we recommend more studies or ways to better detect the condition in those at a high risk of CHF and drugs with multiple actions to treat the said disease. For student nurses, we recommend them to be more responsible, at the same time be aware of the condition of the patient and to treat them as part of the family to express the love, care you want to feel them and to gain the trust and cooperation of their patient.
For the Future Research, we recommend further studies to improve heart transplantation, and to continue to develop new devices to help the damaged heart function and medications that can treat Congestive Heart Failure.
Learning Derived I learned that Congestive Heart Failure is a physiologic state in which the heart cannot pump enough blood to meet the metabolic needs of the body. If experiencing symptoms of CHF, consult to your physician immediately. There are diagnostic procedures that can be done in the said disease. Treatment options are the most common forms of heart failure that cannot be cured, but can be treated by lifestyle changes example of these are: stop smoking, loose weight, avoid alcohol or limit caffeine, eat a low-fat, low sodium diet, and exercise medications. Pharmacologic management are also given and these are the following: Inotropic
medications, ACE inhibitors, Beta Blockers, Diuretics, Vasodilators, Antidsrhythmic drugs. Surgery is not often used in heart failure unless there is a correctable problem.
Angeles University Foundation College of Nursing
Case study
Presented by: Alipio, Allenita Dawn Medina, Joanna Erika Navarro, Krizelle Chiere Reyes, Mikko Carlo
Presented to: Christlyne Jaisy S. Rivera RN, MN

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I.

2. PERTINENT FAMILY HISTORY

GROWTH AND DEVELOPMENT

Mr.Labdab ( 58 y/o) Congested heart

4. HISTORY OF PAST ILLNESS

5. HISTORY OF PRESENT ILNESS

6. PHYSICAL ASSESSMENT (IPPA Ceaphalocaudal Approach)

DIAGNOSTIC AND LABORATORY PROCEDURES

Date ordered: 08-08-10

Date results: 08-08-10

Date ordered: 08-08-10

Potassium level is at the normal level..

Date results: 08-08-10

Date ordered: 08-08-10

Date results: 08-08-10

The creatinine level is within the normal level.

Date ordered: 08-08-10

The T bilirubin level is within the normal level.

Date results: 08-08-10

Date ordered: 08-08-10

The D bilirubin level is within the normal level

Date results: 08-08-10

Date ordered: 08-08-10

The L bilirubin level is within the normal level

Date results: 08-08-10

Date ordered: 08-08-10

The alk. Phos level is within the normal range.

Date results: 08-08-10

The SGPT/ALT level is

within the normal range.

Date results: 08-08-10

Date ordered: 08-08-10

The SGOT/AST level is within the normal level.

Date results: 08-08-10

DIAGNOSTIC/ LABORATOR Y PROCEDURE S

DATE OREDERED DATE RESULTS

ANALYSIS AND INTERPRETATION

Hemoglobin Date ordered: 08-08-10 08-09-10

The hemoglobin level is at normal range.

Date ordered: 08-08-10 08-09-10

The hemotocrit level is at normal range.

0.46 08-0910: 0.50

Date ordered: 08-08-10 08-09-10

Date results: 08-08-10 08-09-10

RBC Count Date ordered: 08-08-10 08-09-10

08-0810: 5.20 08-0910:

The RCB level is at normal range.

Date results: 08-08-10 08-09-10

Nursing Responsibilities for Blood Hematology: Prior to Procedure:

DIAGNOSTIC/LABO RATORY PROCEDURES

DATE OREDE RED DATE RESULT S

ANALYSIS AND INTERPRETA TION

Date ordered: 08-0810 Date results: 08-0810

Urine color is within normal range

Urine transparenc y is normal.

Urine PH is Ph : 5.0 4-6.8 within the normal range

Sp Gravity is Sp Gravity : 1.015 1.05-1.030 within the normal range

Sugar : negative Negative

Pus cells are within normal Microscopic findings: range.

Pus cells : Urine RBC is 0-2 within

normal RBC: 0-2 0-3 range.

Less than 2 Casts/LFP hyaline cast: 6-8