Reference no: EM133469018

Background: T.R. is a 73 year old client was just admitted to the progressive cardiac care unit for an acute exacerbation of heart failure. T.R. was diagnosed with left and right systolic heart failure six years ago. The client has a ACCF/AHA classification of C and NYHA classification of stage III. The client's co-morbidities include: HTN, DM, and GERD.

Shift Assessment: Temperature 98.6 F (oral), HR 120 bpm (apical), B/P 170-92 mmHg, RR 33 (labored), SPO2 89% on 2 L NC, Pain 7/10 in right upper quadrant, and 5/10 chest pain Skin: dusky with cyanotic lips and fingernails, Client appears restless and slightly confused, Heart: Heart sounds revealed S1, S2, S3, client has visible jugular venous distension, and +3 pitting edema in the lower extremities (knees to toes) Lungs: course crackles and wheezing heard in all lung fields, Client's weight has increased 10 lbs since last admission 5 days ago. Current weight 220 lbs.

Diagnostics this Admission:

Chest X-ray: indicates pulmonary congestion, displaced apex of the heart, and cardiac enlargement

Echocardiogram: Ejection fraction of 15%

BNP 750

K+ 3.2 mEg/L

Na+ 133

INR 2.3

Blood Glucose 220

Creatinine 1.9 mg/l

telemetry: A-fib 120 bpm

Medication Orders:

Lisinopril 40 mg PO BID

carvedilol 25 mg PO BID

furosemide 40 mg IVP Q8H

Warfarin

nitroglycerine SL tab PRN

Question 1

The client is receiving 40 mg furosemide IVP. How would the nurse assess for effectiveness of the furosemide in left sided heart failure? In right sided heart failure .

Question 2

The nurse is assessing the clients lab values. Explain the significance of each of the clients lab values? (normal value or abnormal value). What are possible causes of the imbalances if present?

QUESTION 3

The client is receiving carvedilol. Explain to the client why this medication is given. State 2 pre and 2 post assessments the nurse will do during administration.

Question 4

Match the presenting manifestations to left sided or right sided heart failure. (IS IT LEFT OR RIGHT SIDED HEART FAILLURE).

O2 sats <92%

Shortness of breath

3+ pitting edema

O2 sats <92%
course crackles

JVD

QUESTION 5

The nurse is discussing client education. Provide brief client education for the following self-management requirements:

dietary

fluids

weights

signs and symptoms to notify HCP

Question 6

The client is extremely short of breath due to pulmonary edema. What assessment findings would the nurse expect? Describe interventions that the nurse will do to increase oxygenation in this client?