Case Study 1 Heart Failure
Diffi culty: Beginning
Setting: Emergency department, hospital
Index Words: heart failure (HF), cardiomyopathy, volume overload, quality of life
M.G., a “frequent fl ier,” is admitted to the emergency department (ED) with a diagnosis of heart failure
(HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can’t catch my breath and my legs are as big as tree trunks.”
After further questioning you learn she is strictly following the fl uid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge.
1. What error in …show more content…
An important alternative medication is an angiotensin
II receptor blocker (ARB), often called “an ACE without a cough.”
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
chapter 1 Cardiovascular Disorders Case Study 1
6. M.G.’s symptoms improve with IV diuretics. She is ordered back on oral furosemide once her weight loss is deemed adequate to achieve a euvolemic state. What will determine if the oral dose will be adequate to consider her for discharge? [k]
It is critical to help the primary care provider assess whether the change from IV to oral diuretics can maintain a stable weight. One of the fl uid management goals for patients in HF is to maintain a target weight. This is done by monitoring daily morning weight, keeping an accurate I&O, and recording subjective symptoms.
7. M.G. is ready for discharge. What key management concepts should be taught to prevent relapse and another admission?
✽ Hint: Use the mnemonic MAWDS. [k]
The most essential aspect of teaching hospitalized patients without overloading them is to focus on realistic key points. Teaching should be aimed at tips to improve symptoms and prevent readmission. The 5 most important concepts for patients with HF are included in MAWDS instructions. Medications: Take as directed, do not skip a dose, and do not run out of medications.
Activity: Stay as active as you can while limiting your symptoms.
Weight: Weigh every morning. Call if you gain or