Physical Assessment
2+ pitting bilateral lower leg edema
This happens because the back flow of blood and fluid from the right ventricle back into the body
Potassium 4.8
Potassium WNL. Important to look at because it is lost when giving Lasix
Chest XR-opacity of the lung
Determine why the patient is having difficulty breathing.
Furosemide IV 500 mg in 50 mL continuous (Lasix)
The patient is receiving Lasix to try and remove fluid from the body.
Decreased cardiac output related to heart failure as evidence by fatigue, dyspnea, and decreased ejection fraction.
Nursing Goals: patient will demonstrate adequate cardiac output as evidence with blood pressure, pulse rate, and rhythm within normal parameters, no dyspnea.
Interventions: Monitor blood pressures, daily weights, pulse ox and administer oxygen as needed per order, place client in semi or high flowers, apply compression stockings, monitor fluid intake closely, provide low sodium foods.
From decreased cardiac output, back flow of blood into the lungs makes it harder to breathe, and exchange oxygen and carbon dioxide.
Magnesium 2.0
Magnesium WNL. Important because it plays an important role in heart function. If out of normal limits can produce dysrhythmias.
Echocardiogram
EF 24%, shows how well the heart is pumping blood.
potassium chloride 20 mEq twice daily
The patient is receiving potassium supplements because the patient is taking furosemide, which cause you to pee more, causing you to lose potassium.
Goals: The patient will have stabel vital signs, no chest pain, adequate oxygenation, normal lab values, adequate urine output, and remain with in 1500cc fluid restriction.
Interventions: Monitor I &Os, measure urine output, monitor edema, monitor daily weights, vital signs, auscultate lung sounds, keep the head of bed elevated, monitor fluid restriction and low sodium diet, and administer diuretics as ordered.
From the back flow of blood into the lungs
BUN 25 and Creatinine 1.31
The BUN and creatinine is elevated. This could be because the kidneys are not being perfused enough so the kidneys cannot clear urea out efficiently. Also, treatment of Lasix.
Mild ischemia, left and right ventricle dilated, left and right systolic function decreased
uses an EKG to monitor changes in your heart's electrical activity. Also show your heart valves and the movement of your heart muscle. Doctors use both types of stress tests to look for signs that your heart isn't getting enough blood flow during exercise or stress
heparin 5,000 Units every 8 hours
To reduce the risk of clots
Nonpitting edema and distended abdomen
From the back flow of blood from the right ventricle back into the body. The right ventricle is overstretched and can no longer efficiently pump blood to pulmonary arteries.
EF 24%
Very low, should be at least 60%. Shows that the ventricles are not efficiently pumping blood with each beat
CTA of chest/abdomen/pelvis
Aortic and tricuspid valve calcified, moderate ascites in abdomen, moderate bilateral pleura effusion
CT angiography combines a CT scan with the injection of dye. This technique is able to create pictures of the blood vessels in your body.
aspirin 81mg daily
Used to prevent another myocardial infarction
Tachycardia
The patient is tachycardic because the heart isn't pumping out enough blood each time it beats so to try and maintain cardiac output, the heart beats faster to try and compensate.
BNP 1,103
The BNP is secreted in response to stretching of the ventricles. A BNP greater than 100 indicates heart failure.
ECG
Sinus rhythm/sinus tachycardia
Occasional runs of vtach
Heart pumping faster to compensate for decreased cardiac output. Runs of vtach because of a damaged heart.
atorvastatin 80 mg
Used to reduce to risk of a stroke or heart attack with hyperlipidemia