Reference no: EM133228345

Matt is a 70 year old retire man. He has a medical history of Heart Failure. This developed after he experienced a two myocardial infarctions 8 years ago. Both ventricles were affected. Previous chest radiography showed left ventricular hypertrophy.

The death of his wife 2 years ago has led to Matt experiencing several episodes of depression which has been exacerbated by his sons both moving to Western Australia for work. The loneliness and sadness makes it difficult for him to be concordant with his Heart Failure management and sustain the necessary lifestyle adjustments required to prevent exacerbations. This has resulted in several admissions to hospital for management and review of his Heart Failure.

For this current admission, Matt was referred to hospital by his Nurse Practitioner, after recently rapidly gaining weight (currently 110kg), since his previous visit.

The time now is 0800 and nurse have just come on for morning shift. Matt has been on the ward for only two hours after spending approximately 12 hours in emergency waiting for a bed to become available.

Matt appears slightly disoriented. He tells nurse that he has spent the night in the recliner chair beside the bed, sitting upright because 'this is the only way I can get my breath'. He tells nurse he feels terribly tired.

Nurse observe that the 1 litre water jug that he has been drinking from, since coming to the ward, is nearly empty.

Respiratory assessment
Bibasilar posterior crackles
Reduced breath sounds in the bases of both lungs
Increased work of breathing
Patient producing pink-tinged frothy sputum

Cardiac assessment
ECG: indicative of atrial fibrillation
Skin is cool and clammy

Vital Signs
RR: 28 bpm
Sp02: 94% on 2lt via nasal prongs
BP: 105/82 mmHg
HR: 122bpm
Temp: 36.5oC

1. Describe the physiological and pathophysiological mechanisms for Matt's presentation of 'increased work of breathing'. Identify any other data that supports explanation.