case study: heart failure

Please include the attached cover page and evaluation form to your case study assignment and upload as MS Word file under this assignment. I plan to return graded assignments with comments via Google Docs.

INSTRUCTIONS

1. Please read the patient case and questions thoroughly and answer in sentence(s).

2. Type double-spaced using 12-font (use only one style for the entire document).

3. You must include the reference(s) in APA format. References begin on a separate page from the last page of your completed work and must list all references. Do not use unverified references such as YouTube videos or certain websites.

Please refer to Purdue Online Writing Lab. APA style. Resources available by Control + clicking on the following link: https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html

4. Please type answer after each question and print starting from page 5 with question and answer format, there is no need to print the instructions and patient case (e.g., question 1 then answer, questions 2 then answer, etc.). Electronic submission via email will not be accepted.

5. This assignment is not a group project. All question should be answered in your own words. Plagiarism will lead to a ZERO for all students involved.

6. Your completed work should be submitted in-person to your lecture instructor on time by the due date indicated on the syllabus. Due date is Wednesday April 1^st, 2020.

PATIENT CASE

History of Present Illness

L.M. presented to the emergency department (ED) late one evening complaining of a “racing heartbeat”. She is an obese, 67-year-old white female, who has been experiencing increasing shortness of breath for the past month and marked swelling of the ankles and feet for the past two weeks. She feels very weak and tired most of the time and has recently been waking up in the middle of the night with severe difficulty breathing. She has been sleeping with several pillows to keep herself propped up. Four years ago, she suffered an anterior wall (left ventricle) myocardial infarction (MI). She received coronary artery bypass surgery 3 ½ years ago for obstructions in the left anterior descending and left circumflex coronary arteries. The patient is admitted to the hospital for further thorough examination.

Family History

Atherosclerosis – Father

Myocardial infarction (MI) – Father died of a heart attack (MI)

Cerebral vascular accident (CVA) – Mother had several CVAs

Medical History

MI in 2016

Hypercholesterolemia x 9 years

Osteoarthritis

Gout

Obesity

Three-pack per day cigarette smoker x 30 years but quit smoking after her MI

Uses alcohol infrequently

Surgical History

Coronary artery bypass surgery (CABG) after MI in 2016

Medication

Allopurinol 200mg daily

Atorvastatin 20mg daily

Aspirin 81mg daily

Metoprolol succinate ER 50 mg daily

Ramipril 5mg daily

Allergies

Nuts, shellfish, strawberries – rashes and hives

Hydralazine – itchiness and hives

Physical Examination

Vital signs

BP= 125/80 (left arm, sitting)

HR = 130 bpm and regular

RR = 28 breaths per minute and labored

BT = 98.5 °F (oral)

SpO2 = 92% on room air

Weight = 215 lbs, Height = 5’5’’

Skin

Pale, cool and sweaty extremities, slightly diaphoretic

Neck

Neck supple with no bruits over carotid arteries

Positive JVD

Lungs

Bibasilar rales with auscultation

Heart

PMI (point of maximal impulse) displaced laterally

Normal S1 and S2 with distinct S3 at apex

No murmurs

Abdomen

Soft to palpation with no masses

Significant hepatomegaly and tenderness on deep palpation

Extremities

2+ pitting edema in feet and ankles extending bilaterally to mid-calf region

Cool and sweaty skin

Radial, dorsalis pedis, and posterior tibial pulses present

Neurological

Alert and oriented to place, person, time, and situation

Cranial and sensory nerves intact

Laboratory Tests

Chest X-ray

Prominent cardiomegaly and consistent with pulmonary edema

Echocardiogram

Ejection fraction (EF) = 36%

Blood Test

Laboratory Blood Test	Result
Na+	153 mEq/L
K+	3.2 mEq/L
BUN	45 mg/dL
Creatinine	2.3 mg/dL

QUESTIONS

Question 1. Based on the information given above, do you suspect that this patient has developed left-sided HF, right-sided HF, or total (both left and right HF)?

Question 2. How did you arrive at your answer to question 1?

Question 3. What is the most likely cause for H.J.’s heart failure? (Identify only one)

Question 4. Identify three risk factors that likely contributed to the patient’s heart attack (MI) in 2014.

Question 5. Why is the patient taking aspirin?

Question 6. Why is this patient tachycardic? Explain the pathophysiology.

Question 7. Why is this patient tachypneic? Explain the pathophysiology.

Question 8. Explain the pathophysiology of abnormal skin manifestations in this patient’s compensated HF.

Question 9. Are jugular vein distension (JVD) and hepatomegaly signs of left-sided HF or right-sided HF? Explain the rationale.

Question 10. Which abnormal cardiac exam and chest x-ray findings closely complement one another?

Question 11. Explain the pathophysiology of the abnormal serum Na+ and K+ levels in this patient’s compensated HF.

Question 12. Explain the pathophysiology of the abnormal serum BUN and creatinine levels.

WE’VE HAD A GOOD SUCCESS RATE ON THIS ASSIGNMENT. PLACE THIS ORDER OR A SIMILAR ORDER WITH PapersSpot AND GET AN AMAZING DISCOUNT