Heart Failure Case Study

JoAnn Smith, 72 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Gas Exchange
2. Fluid and Electrolyte Balance
3. Clinical Judgment
4. Patient Education
FUNDAMENTAL Reasoning: STUDENT
History of Present Problem:
Heart Failure
© 2016 Keith Rischer/www.KeithRN.com
JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and systolic heart
failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. She presents to the
emergency department (ED) for shortness of breath (SOB) the past three days. Her shortness of breath has progressed
from SOB with activity to becoming SOB at rest. The last two nights she had to sleep in her recliner chair to rest
comfortably upright. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse.
She has noted increased swelling in her lower legs and has gained six pounds in the last three days. She is being
transferred from the ED to the cardiac step-down where you are the nurse assigned to care for her.
Personal/Social History:
JoAnn is a retired math teacher who is unable to maintain the level of activity she has been accustomed to because of the
progression of her heart failure the past two years. She has struggled with depression the past two years and has been
more withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Systolic hearth failure
Ischemic cardiomyopathy
Ejection fraction of 15%
Increased SOB, even at rest
Speak in partial sentences
Increased edema in legs
Gained six pounds in last 3 days
Her heart is not pumping blood to the tissues and organs as it should
Her heart muscle was damaged and is weakened, probably due to her MI
four years ago
Ejection fractions should be above 50%; her heart is doing a poor job at
pumping out blood to her body
It is not normal to be SOB, especially at rest; her lungs are struggling
She is so short of breath that she can not even speak without stopping to
breathe
Increased edema means that fluid is stuck in third spaces in the tissue (not
is the vascular system or the cells, but in between)
Gaining weight is a sure sign of fluid retention
RELEVANT Data from Social History: Clinical Significance:
Unable to maintain level of activity
Depression past two years
She is unable to properly care for herself or perform ADL’s if she gets so
out of breath
Depression slows the healing process, especially when patients are less
likely to comply with therapies