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Adult Nursing NUR 304 Case Study

Adult Nursing NUR 304 Case Study

Sample Answer 

Adult Nursing NUR 304 Case Study

  1. Because the patient cannot breathe or talk easily, prioritize the immediate nursing assessments upon admission

Upon admission of a patient presenting with symptoms and signs of acute heart failure, such as severe dyspnea, a rapid nursing assessment should be performed to determine the patient’s respiratory and hemodynamic status and electrolyte and fluid status (Mebazaa et al., 2015). This is achieved by checking the patient’s vital signs and assessing the patency of the airways. This is necessary for the determination of treatment measures for the patient.

  1. Considering the process of heart failure, rationalize each of the patient symptoms. 

A patient suffering from heart failure presents with dyspnea and orthopnea. The two symptoms develop when the failing left ventricle cannot empty completely (Mesiha et al., 2017). This leads to the development of pulmonary congestion with subsequent transudation of plasma into the alveolar spaces, impairing the process of gaseous exchange. The resulting hypoxia and hypercapnia stimulate the medullary respiratory center causing an increase in respiratory rate. Pillow Orthopnea in the patient is caused by the increased respiratory rate, which makes him face shortness during breathing. The inadequate tissue oxygenation results in weakness and exertion. The elevated right ventricular pressure impairs venous return, causing accumulation of fluid in the lower extremities, hence ankle edema.

  1. Based on, identify problems for this patient.

There are two major issues with the patient. First, the patient has fluid accumulated in the lower extremes, causing ankle edema. The second problem with the patient is insufficient tissue oxygenation.

  1. Explain the rationale for the medication and treatment ordered.

The patient was put on oxygen therapy since her respiration had been impaired by alveolar congestion and edema. Furosemide is administered to manage hypervolemia, which is responsible for pulmonary and ankle edema, by inducing diuresis. Digoxin, a positive inotropic drug, is administered to enhance the contractibility of the failing heart. Morphine, an opioid analgesic, is given to treat the pain commonly associated with heart failure or causes of heart failure such as myocardial infarction.

  1. What should the nurse include in the discharge instructions for self-care for patients with heart failure?  

The nurse needs to include diet and lifestyle modification advice on the discharge sheets (Ignatavicius, 2017). This is because there is a need for the patient to live a healthy life and be safe from any similar condition in future, as heart failure is much associated with an individual’s diet. For this case, the nurse should include that the patient should avoid too much salt in food and concentrate more on taking cholesterol-free foods such as green grams, etc., vegetables, and whole grains.


Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S., … & McDonagh, T. (2015). Recommendations on pre‐hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. European journal of heart failure17(6), 544-558.

Mesiha, N., Mazhar, N., Tieku, S., Hasan, S., & Goldsmith, D. (2017). Not Every Orthopnea Means Heart Failure. In C42. DYSPNEA: CASE REPORTS (pp. A5517-A5517). American Thoracic Society.

Ignatavicius, D. D., Workman, M. L., & Rebar, C. (2017). Medical-Surgical Nursing-E-Book: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.

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Adult Nursing NUR 304 Case Study

Adult Nursing NUR 304 Case Study 3 Fall 2018
Please download the attach Case Study below, answer each question with explanation/rationale to receive FULL credit for your answer.
Make sure to add a rational to each answer to

74yearold woman was admitted to the

Adult Nursing NUR 304 Case Study

Adult Nursing NUR 304 Case Study

hospital with heart failureShe had been growing progressively weaker and also had ankle edemadyspnea on exertion, and three-pillow orthopnea. On admissionshe is severely dyspneic and can answer questions only with one-word phrases. She is diaphoretic, with a respiratory rate of 28/min, a heart rate of 132 beats/min, and BP 98/70. Her oral temperature is 36.7 C and her SaO2 89%. She is extremely anxious. The nurse applies immediately oxygen at 2 L via NC as per unit protocol.

The physician orders: Insert PIV then start Dobutamine 3 mcg/kg/hr

Furosemide 40 mg IV stat, Digoxin 0.5 mg orally stat, then 0.125 mg every 6 h for three does with ECG before doses 3 and 4; morphine 2 mg IV stat, and then 2 mg IV every 1-2 h prn, increase O2 to 4 L/min.

Schedule patient for an echocardiogram, no added salt diet, weigh patient daily and record: Strict I&O.

Answer the questions below and give rationales for your answer.

  1. Because the patient cannot breathe or talk easily, prioritize the immediate nursing assessments upon admission
  2. Considering the process of heart failure, rationalize each of the patient symptoms.
  3. Based on the assessment, identify problems for this patient.
  4. Explain the rationale for the medication and treatment ordered.
  5. What should the nurse include in the discharge instructions for self-care for patients with heart failure?

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