Congestive Heart Failure Case Study

Objectives:
At the end of this lecture the student will be able to:
1. Define congestive heart failure
2. Describe the signs and symptoms of congestive heart failure (CHF)
3. List nursing interventions for this patient
Molly Sawyer is a 66 year old female that arrives in the Emergency Room per EMS. She
complains of shortness of breath for 1 week which seems to have gotten worse today. Ms.
Sawyer complains of persistent cough especially at night.
Allergies: NKDA
Medications:

Clonidine
Digoxin
Insulin 70/30 and Regular

History:

DM (Diabetes Mellitus)
HTN
Heart problems

Assessment:

Nailbeds dusky
Sitting upright
Difficulty talking
Skin cool and moist
Ankle edema
Rales noted right middle lobe and lower lobes bilaterally

Vital Signs:
BP 218/110
HR 120
RR 36
T 38.1
ABGs (RA)
ph
7.48
paCo2
30
paO2
80
Sao2
95%
Hco3
24

Lab values:
Na 135
K 3.9
Hgb 12.5
Hct 33%
Dig 0.6
Creat 1.9
BUN 10

CXR Bilateral pulmonary congestion

12 Lead EKG Sinus tachycardia with occasional PVCS
Old Anterior MI
1. From the patients chief complaint and your initial assessment, what is the patients primary
problem?

2.
3.
4.
5.
6.

Describe the pathophysiology of CHF (congestive heart failure).

What are the signs and symptoms of heart failure?
What pharmacologic agents are used to improve cardiac performance in patients with CHF?
What factors contribute to the patients heart failure?
What nursing diagnosis apply in this case?