Name: __________________________________________________
Assignment: Cardiac Clinical Reasoning
Data Collection:
Patient History
- What is the relationship of the patient’s past medical history and his current medications?
Complete the table on page 2 for this patient’s home medications.
(2 points each = 8 pts total)
Classification: List the medication’s therapeutic and pharmacologic classification that is appropriate to the condition from the patient’s medical history.
Indications: Of Mr. Hart’s home medications listed in the table, identify the condition(s) that it is treating from this list below from the patient’s medical history. There may be more than one answer. (In other words, why is this patient taking this medication?)
Past Medical History for Mr. Hart:
Hypertension
Heart Failure
Hyperlipidemia
Myocardial infarction
Coronary Artery Disease
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Data Collection:
Patient’s Primary Symptoms, Vital Signs, and Diagnostic Tests
2.
Primary Symptoms:
Patient comes to the clinic concerned that is experiencing episodes of chest tightness and a rapid heartbeat on exertion, has developed a persistent cough, and is increasingly fatigued with occasional dizziness. He reports that he is noticing shortness of breath on exertion with some chest discomfort and is becoming increasingly SOB even at rest. He has had to sleep with 3 pillows to keep from becoming SOB at night the last 2 weeks. He reports difficulty getting his shoes on the last month because of increased swelling around his ankles. He weighs himself once a week and today his weight has increased from 255 lbs. to 264 lbs. over the last 7 days.
- Which findings in this patient indicate Left-sided failure and which indicate Right-sided failure? (4 points)
| Left-sided failure findings in this patient: |
Right-sided failure findings in this patient: |
- Explain what is happening physiologically to this patient and how it is resulting in his symptoms. Be specific and complete.
(1 point)
- Of these patient’s reported signs and symptoms in his history and in the Nurse’s Notes, which 3 findings require the most immediate attention by the nurse? (1 point)
_______ Weight gain
_______ Ankle swelling
_______ Persistent cough
_______ Increasing fatigue
_______Irregular heart rhythm
_______ Chest tightness, Chest discomfort
_______ Shortness of breath on exertion and rest
- What is the relationship or clinical significance between this patient’s vital signs and the problem of heart failure?
(a. and b. 3 points each = 6 points total).
| Relevant Vital Signs: a. Heart rate and character What is normal: The patient’s data (rate, character): b. Respirations: Rate and lung sounds What is normal: Rate: Sounds: The patient’s data: Rate: Sounds: |
Relationship or clinical significance to Heart Failure: (What is causing the abnormality in this patient? Or is it normal?) a. b. |
- What is the relationship or clinical significance between this patient’s diagnostic test results and his heart failure?
(a., b. c. and d = 3 points each = 12 total pts)
| Diagnostic test results: |
Clinical significance of these results and the relationship to the patient’s Heart Failure or to the patient’s symptoms: (Why were these tests ordered? What do the tests reveal about this patient’s condition? What do the tests mean for this patient?) |
| a. BNP What is normal: The patient’s data: b. Ejection fraction What is normal: The patient’s data: c. Troponins What is normal: The patient’s data: |
a. b. c. |
| d. Electrocardiogram: Rhythm: Is it Regular or Irregular? ___________________________ P wave present (yes or no)? ______________________________________ |
| What is the interpretation of this rhythm: |
Identifying the problem
(2 points)
- Based on the data collection findings, the primary medical diagnosis for Mr. Hart is:
- An exacerbation of heart failure.
The nurse notes the patient’s problems of activity intolerance and fluid volume overload.
- Based on the data collection findings, these symptoms are the result of a decreased:
Choose one
________ Blood pressure
_________Cardiac output
_________ Heart rate
- Understanding the primary physiological problem for this patient currently, the client is at highest risk of:
Choose one
________ Dysrhythmia
________ Pulmonary edema
________ Myocardial Infarction
As evidenced by the patient’s:
Choose one
_______ EKG
_______ BNP level
_______ Troponins
_______ Chest x-ray
Collaborative Care/ Nursing:
Interventions
(2 points)
- Of these potential nursing interventions, choose if the intervention is indicated at this time or non-essential (not necessary) or contraindicated for this patient.
Place an X or checkmark in the appropriate column. (1 point)
| Nursing intervention | Indicated | Non-essential | Contraindicated |
| Place client in Semi-Fowlers or high Fowler’s position | |
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| Keep a water pitcher and ice chips at the client’s bedside |
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| Reposition every 2 hours when in bed |
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| Schedule activities with frequent periods of rest | |
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| Observe patient for nausea, anorexia, or visual disturbances |
- Choose one expected outcome for the patient problem. Not all outcomes will be used. (1 point)
Patient problem Expected outcome
Activity intolerance__________ a. Respiratory rate and oxygen saturation within normal range
Increased fluid volume_________ b. The client performs activities without fatigue
- Intake and output equal with no peripheral edema
- The patient reports no dizziness when standing.
Collaborative Care/ Medical Management:
Interventions
- What is rationale for the healthcare provider’s prescriptions? How is each order helping to resolve or address the problems associated with Heart Failure?
(a.- d., 2 points each = 8 pts)
| HCP Prescription | Rationale for this order/ How it helps resolve or address primary problems associated with Heart Failure: |
| a. Daily weights, I & O, anti-embolism stockings, fluid restriction | a. |
| b. The daily dose of eplerenone/Inspra | b. |
| c. The one-time stat dose of furosemide/Lasix |
c. |
| d. The consult for possible cardioversion | d. |
Evaluation
(5 points)
- The patient is stabilized and ready for discharge.
- Explain the classification, purpose, and intended therapeutic effect of adding warfarin/Coumadin to Mr. Hart’s medications:
- Classification of warfarin and its purpose for Mr. Hart:
- In reviewing Mr. Hart’s medications, what must be brought to the attention of the HCP?
- Explain the classification, purpose, and monitoring required when adding digoxin/Lanoxin to Mr. Hart’s medications:
- Classification of digoxin and its purpose for Mr. Hart:
- What specifically is monitored by the nurse in a patient taking digoxin?
Evaluation, cont.
- Which statements by the client indicates that he understands the evidence-based follow-up activities and observations required to promote health and wellness, even with his chronic condition of heart failure? (1 point)
Select all that apply
_________ “I will take a daily walk and rest as needed.”
_________ “I should add more leafy greens into my diet.”
_________ “I will eat my normal diet as long as I do not add table salt.”
________ “I will read the labels on all foods to ensure my diet in low in sodium.”
_________ “I will take a laxative to make sure that I have a bowel movement every day.”
_________ “I will contact my health care provider if I gain more than 3 pounds in a week.”
_________ “I may include red wine in my diet occasionally to prevent further damage to my heart.”
_________ “I will return to the clinic to have my blood checked for potassium and for my digoxin level.”
_________ “I will check my radial pulse every day and hold my heart medication if my pulse is below 65.”
_________ “I will weigh myself once every week on the same scale and at the same time to monitor for changes.”
