Heart Failure

This learning module will give you a chance to explore Heart Failure using the nursing process.

Mr. Sayed Burnab, a 64-year-old male is a retiree and was admitted to the hospital.  He is accompanied by his daughter. He is 105kg at a height of 172cm so his calculated body mass index (BMI) was 30.9 indicating that he was overweight. When admitted, patient complained of shortness of breath for 2 weeks and was continuing to worsen on the day of admission. He was also experiencing orthopnea, fatigue, paroxysmal nocturnal dyspnea and leg swelling that extended up to his thigh. He was admitted to the hospital for to the same problem last year.

Mr. Sayed Burnab was diagnosed with heart failure 3 years ago and he was diagnosed with hypertension 5 years ago. Before being admitted to the hospital, the patient was taking frusemide 40mg, aspirin 150mg, metoprolol 50mg, amlodipine 10mg, and simvastatin 40mg for his hypertension and heart failure. Patient does not have an allergy to any medication, and he does not take any traditional or natural medicines at home. His family history revealed that his father had died of ischemic heart disease 4 years ago while his brother has hypertension. As for his social history, he smokes 2-3 cigarettes a day for 35 years and drinks alcohol occasionally.

On examination, he is found to be alert and oriented, however he was having foot edema that extended up to his knee. The patient also has decreased air entry to both lungs with rhonchi. His body temperature is normal. His blood pressure was found to be elevated upon admission with a record of 159/100 mmHg and with an irregular pulse rate at 85beats/min. His echocardiogram showed that he had left ventricle hypertrophy while his chest X-ray revealed that the patient had cardiomegaly.

Lab investigations such as full blood count, liver function test, urea and electrolyte test as well as cardiac enzymes were done upon admission. His creatinine concentration was found to be 143µmol/L. There was also blood found in the urine and the echocardiography showed that the patient had sinus tachycardia. In addition, the ECG test that was performed on day 1 indicated that there was T-wave inversion. The patient’s INR was 1.04 which was lower than normal while APTT was found to be slightly higher (59.4 seconds). His random blood glucose was found to be normal during his hospitalization.

The physician has listed his diagnosis as congestive heart failure (CHF) with fluid overload. The management plan included intravenous frusemide 40mg twice daily, aspirin 150mg once daily, simvastatin 40mg once at night and ramipril 2.5mg once a day. The patient was also asked to restrict his fluid intake to 500ml per day. Oxygen therapy was given to patient at 40% FiO2 high flow using a face mask when the patient is experiencing shortness of breath.