University of South Alabama

College of Nursing
AHN 301

CLINICAL PREPARATION SHEETS

Student’s Name: Angela Andrews

Patient’s Room #: 205 Age: 73 Date of Admission: 10/30/2010

Medical Diagnoses (why are they here) Affecting Nursing Care:

Congestive heart failure

Secondary Diagnoses (History of):

Hypertension, atrial fibrillation, and acute renal failure

Chief Complaint: The patient complains of “coughing up blood and bloody sputum”.

Recent surgery: n/a

I. Pathophysiology

Definition: Heart failure is a general term for the inability of the heart to work as a

pump. It results from a number of acute and chronic cardiovascular problems. The

major types of heart failure are left sided and right sided failure. Left sided heart

failure is commonly known as congestive heart failure. Left sided heart failure can be

divided into two systolic heart failure and diastolic heart failure. Systolic heart failure

results when the heart cannot contract hard enough during systole to eject an adequate

amount of blood into circulation. Diastolic heart failure occurs when the left ventricle

cannot relax adequately during diastole. The left ventricle stiffens and does not fill

with enough blood to maintain normal cardiac output. My patient’s congestive heart

failure was left sided and right sided. Left sided heart failure often leads to right sided

heart failure (Ignatavicius & Workman 2010).

Etiology: Left sided heart failure can be caused by hypertension. Preload is the

volume of blood that stretches the ventricle prior to contraction. Preload increases

with decreased contractility. Also, afterload increases because the heart has to pump

against increased resistance caused by hypertension. The ejection fraction is the

percentage of blood ejected from the heart during systole. In systolic heart failure, the

ejection fraction will drop below 40% with ventricular dilation. As the ejection

fraction decreases, blood flow to the tissues is decreased and blood accumulates in

pulmonary vessels (McCance & Huether 2010).

Signs and Symptoms: Characteristics of left sided heart failure include decrease

blood flow to the tissues from low cardiac output and pulmonary congestion from

increased pressure in the pulmonary vessels. Right sided heart failure can be caused

by left ventricular failure and pulmonary hypertension. In right sided heart failure, the

right ventricle does not empty completely. Increased volume and pressure develop in

the veins, and peripheral edema results (Ignatavicius & Workman 2010).

Complications:

Medical Management:
 Nursing Management:

II. Physician’s Orders

a. Medications

Scheduled Meds
Medication Dose Route Frequency Time
Albuterol- 4 puffs Metered dose 4x/day 0900/1300/1700/2100
ipratropium inhaler
(COMBIVENT)
Methyl 125mg IV q6hrs
prednisolone

Potassium 10mEq capsule

chloride
PRN Meds
Insulin aspart Sliding scale 2 subq
(Novolog) moderate
Ipratropium- 3 mL Nebulizer q4hrs
albuterol (DUO-
NEB)
Morphine 2-5mg IV q1hr

B.ALL OTHER PERTINENT/CURRENT PHYSICIAN ORDERS: (Including wound care,

IV fluids, activity, etc.)

Diet: Cardiac diet (2g sodium)

Activity order: up in chair with assistance

Vital signs schedule: q 4 hrs

Blood Glucose/Accuchecks (schedule):

Wound Care (what, where, how often):

IV site/type/date of insertion/dressing change:

IV fluids/rate: 0.9 normal saline, 150 ml/hr

Foley/date of insertion/indication: n/a

Code Status: FULL

Procedures scheduled for today/tomorrow:

Telemetry rthythm if applicable:

 REFERENCES

McCance, K., Huether, S., Brashers, V., Rote, N. (2010). Pathophysiology: The Biologic Basis

or Disease in Adults and Children. Philadelphia, PA: Mosby Elsevier.

Workman, M.L. & Ignatavicius, D.D. (2010). Medical Surgical Nursing: Critical thinking for

collaborative care. (6th ed.). St. Louis: Elsevier Saunders.