NURSING med surg CASE STUDY – HEART FAILURE Donald 

Bergman; A 67-year-old male who was admitted to the telemetry unit 1 

day ago for medical management with a diagnosis of chronic heart 

failure (HF)

Donald Bergman

Patient Assignment

D.B. is a 67-year-old male who was admitted to the telemetry unit 1 day ago for medical management

with a diagnosis of chronic heart failure (HF). D.B. has a 20-year history of hypertension and had an MI

6 years ago. He began having fatigue, tachycardia, and dependent bilateral lower extremity edema about

18 months ago, and was diagnosed with right ventricular HF. He was already taking enalapril for

hypertension and was prescribed furosemide, potassium, and digoxin after his HF diagnosis. D.B.’s

symptoms have worsened over the last month. Upon admission 1 day ago at 0800 VS: T 36.4° C (97.5°

F), BP 156/98, P 126 and regular, R 36 and labored. O2 saturation 88% on RA. He had 3+ pitting edema

in his feet and ankles, dyspnea, tachycardia, JVD, and crackles bilaterally in his lungs. He stated that he

has been unable to “get enough air,” has been sleeping in the recliner, and has gained 5.5 kg (12 lb) in

the past month. Admission weight 100 kg (220 lb), height 177.8 cm (70 in). He is a full code.

NURSING med surg CASE STUDY – HEART FAILURE Donald 

Bergman;a 67-year-old male who was admitted to the telemetry unit 1 

day ago for medical management with a diagnosis of chronic heart 

failure (HF)

Admission Orders

Enalapril 5 mg PO bid, digoxin 0.25 mg PO daily, potassium 20 mEq PO daily, valsartan 40 mg PO bid,

furosemide 0.1 mg/kg/hr continuous IV infusion, O2 2L/min via nasal cannula to keep O2 saturation at or

above 92%. Bed rest with bathroom privileges. 2000-calorie DASH diet. 1500 mL/day fluid restriction.

Daily weights. I&O. CBC, BMP, BNP, cardiac enzymes, ECG, echocardiogram, and chest x-ray. Admit

to telemetry unit with 24-hour monitoring.

1. What signs and symptoms did D.B. have 18 months ago when he was diagnosed with right ventricular

HF?

● He began having fatigue, tachycardia, and dependent bilateral lower extremity edema 3+.