Nursing homework help

1509 Unit 8: Cardiac Perfusion

Heart Failure Case Study

10 points

Betty Johnson, a 65-year-old female, was admitted to the emergency department 2 days ago with worsening lower extremity edema and sudden onset of shortness of breath. She was diagnosed with an exacerbation of congestive heart failure (CHF) and admitted to a cardiology unit for close observation. Mrs. Johnson was treated with diuretics and appeared to be improving greatly.

On your morning shift, you received report from the nurse that she had just hung a bag of normal saline at 100 ml/hr, and that Mrs. Johnson was stable. You checked on your other patients before seeing Mrs. Johnson and found her with labored respirations, the IV pump set to 1000 ml/hr, the normal saline empty, and her oxygen unplugged. You quickly reconnected her oxygen and noted crackles in all lung fields. Mrs. Johnson was having trouble speaking, and her vital signs showed BP 212/110, HR 120, RR 36, and SpO2 85%. She had 4+ pitting edema with weeping blisters on her lower extremities, and she was disoriented to time but still able to say her name and the hospital she was in.

You called for the rapid response team, who arrived and recommended 80mg furosemide IV, placing Mrs. Johnson on Bipap with a rate of 14, 60% FiO2, and 5 of PEEP. You also obtained STAT ABG, CMP, and BNP and upgraded her to the ICU. Prior to transport, you emptied her Foley, which had 400ml of urine. Her vital signs improved to BP 178/89, HR 92, RR 18, and SpO2 97%. You completed the orders and safely transported Mrs. Johnson to the ICU, giving report to the receiving nurse (Anna RN).

Answer the following questions based on this scenario: (1 point per question)

1. What was the error with the IV pump that the nurse noticed, and how did it contribute to Mrs. Johnson's worsening symptoms?

2. In relation to Mrs. Johnson's current condition, explain how each of the following abnormal vital sign values is related:

a. Blood pressure (BP)

b. Heart rate (HR)

c. Respiratory rate (RR)

d. Pulse oximetry (SpO2)

3. Besides vital signs, what other assessment findings are abnormal or concerning, and why?

4. What are the common causes and risk factors for congestive heart failure, and how do they contribute to the development of the condition?

5. What is the pathophysiology of pulmonary edema, and how does it develop in congestive heart failure?

6. What are the signs and symptoms of worsening congestive heart failure, and how should healthcare providers monitor and manage these symptoms?

7. How does the administration of furosemide help manage congestive heart failure, and what are the potential adverse effects of this medication?

8. What is the importance of obtaining arterial blood gases (ABG) and a B-type natriuretic peptide (BNP) in Mrs. Johnson's current condition?

9. What nursing interventions should be implemented to prevent future exacerbations of Mrs. Johnson's CHF?

10. What is the role of the rapid response team, and how did their prompt response impact Mrs. Johnson's outcome?