Heart Failure
JoAnn Smith, 72 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Gas Exchange
2. Fluid and Electrolyte Balance
3. Clinical Judgment
4. Patient Education
5. Communication
6. Collaboration
UNFOLDING Reasoning Case Study: STUDENTHeart Failure
History of Present Problem:
JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and systolic heart
failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. She presents to the
emergency department (ED) for shortness of breath (SOB) the past three days. Her shortness of breath has progressed
from SOB with activity to becoming SOB at rest. The last two nights she had to sleep in her recliner chair to rest
comfortably upright. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse.
She has noted increased swelling in her lower legs and has gained six pounds in the last three days. She is being
transferred from the ED to the cardiac step-down where you are the nurse assigned to care for her.
Personal/Social History:
JoAnn is a retired math teacher who is unable to maintain the level of activity she has been accustomed to because of the
progression of her heart failure the past two years. She has struggled with depression the past two years and has been
more withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
MI four years ago,
increase shortness of breath at rest; can only
speak in partial sentences,
ischemic cardiomyopathy with EF of 15%
last two nights slept in recliner
increased swelling in lower legs
gained 6 pounds in last 3 days
MI is significant because it decreases heart function due to death of
myocardial muscle
EF of 15% shows that the heart is having a hard time pumping blood out to
rest of the body therefore starving it of oxygenated blood.
Weight gain and increased swelling signifies she is fluid overloaded and it
can be reason why she is having a hard time talking, breathing, being
active and why she has to sleep in a recliner the past 2 nights
RELEVANT Data from Social History: Clinical Significance:
Retired math teacher, recent widow, history of
depression, decreasing activity level
Depression might affect her enthusiasm to recover, to stick to a therapy
regimen
Category | Exam (elaborations) |
Release date | 2021-10-08 |
Pages | 19 |
Language | English |
Comments | 0 |
Sales | 0 |
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