A patient diagnosed with early-stage heart failure presents with mild shortness of breath on exertion and slight bilateral ankle edema. Which of the following nursing interventions is most appropriate to address the patient's symptoms?

B) Advise the patient to monitor daily weight and report a gain of more than 2 pounds in a day

A) Encourage the patient to increase fluid intake to promote renal function

B) Advise the patient to monitor daily weight and report a gain of more than 2 pounds in a day

C) Recommend the patient to avoid all physical activities to prevent fatigue

D) Suggest the patient reduce salt intake to manage fluid retention

During the initial assessment of a patient with early-stage heart failure, which of the following findings is most indicative of fluid retention?

C) Slight bilateral ankle edema

A) Clear breath sounds bilaterally

B) Regular heart rate of 72 bpm

C) Slight bilateral ankle edema

D) Oxygen saturation of 96% on room air

A patient with heart failure with preserved ejection fraction (HFpEF) has been advised to manage their condition through lifestyle modifications. Which of the following is a key non-pharmacological intervention for this patient?

A) Reducing dietary sodium intake

D) Avoiding all sources of dietary potassium

What is the primary reason for monitoring a patient's B-type Natriuretic Peptide (BNP) levels in heart failure management?

B) To evaluate the effectiveness of heart failure treatment

C) To monitor blood glucose levels

D) To check for electrolyte imbalances

What is the primary reason for scheduling regular follow-up appointments for a patient with heart failure?

B) To evaluate the effectiveness of the treatment plan

A) To monitor the patient's adherence to exercise routines

B) To evaluate the effectiveness of the treatment plan

C) To ensure the patient is taking medications correctly

D) To provide social support and encouragement

What is the primary purpose of introducing a low-dose diuretic in this patient's treatment plan?

D) To manage electrolyte imbalances

During the follow-up appointment, the healthcare team decided to introduce a low-dose diuretic to the patient's regimen. What is the primary reason for adding a diuretic in this scenario?

B) To manage occasional breathlessness and prevent fluid overload

A) To increase the patient's energy levels

B) To manage occasional breathlessness and prevent fluid overload

C) To lower the patient's blood pressure

D) To correct electrolyte imbalances

What is the primary reason for monitoring daily weight in a patient with heart failure?

A) To assess nutritional status

C) To determine medication effectiveness

D) To monitor exercise tolerance

Which nursing assessment finding most indicates the effectiveness of the patient's current heart failure management plan?

B) Weight decrease by two pounds

A) Respiratory rate of 18 breaths per minute

B) Weight decrease by two pounds

C) Blood pressure of 128/78 mmHg

heart failure - Nursing Case Study

Pathophysiology

• Primary mechanism: Heart failure occurs when the heart muscle becomes weakened or stiff, leading to its inability to pump blood effectively. This results in reduced blood flow to meet the body's needs.

• Secondary mechanism: The kidneys respond to decreased blood flow by retaining fluid and salt, which increases blood volume. This puts additional strain on the heart, worsening the heart's ability to function and leading to fluid buildup in the lungs and other tissues.

• Key complication: The fluid retention can cause symptoms like swelling in the legs, shortness of breath, and fatigue, significantly impacting a patient's quality of life and requiring careful management.

Patient Profile

Demographics:

65-year-old female, retired school teacher

History:

• Key past medical history: Hypertension, hyperlipidemia

• Current medications: Lisinopril 10 mg daily, Atorvastatin 20 mg daily, Aspirin 81 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Mild shortness of breath on exertion

• Key symptoms: Fatigue, occasional mild ankle swelling

• Vital signs: Blood pressure 128/78 mmHg, Heart rate 72 bpm, Respiratory rate 18 breaths per minute, Temperature 98.6°F, Oxygen saturation 96% on room air

Section 1

Initial Assessment Findings:

During the initial nursing assessment, the patient presented with mild shortness of breath on exertion, which she described as occurring primarily when climbing stairs or engaging in light housework. On inspection, there was slight bilateral ankle edema, with the skin appearing slightly shiny but without notable discoloration. Auscultation of the lungs revealed clear breath sounds bilaterally, with no wheezing or crackles, indicating that pulmonary congestion was minimal at this stage. Heart sounds were regular, with no murmurs, indicating stable cardiac function for her condition.

The patient's vital signs remained stable, with a blood pressure of 128/78 mmHg and a heart rate of 72 bpm. Her respiratory rate was 18 breaths per minute, and oxygen saturation was 96% on room air, which was satisfactory given her mild symptoms. The patient reported feeling generally fatigued, which she attributed to interrupted sleep due to frequent nocturia. This aligns with potential fluid retention, a common issue in early-stage heart failure.

The nurse noted that the patient's weight had increased by approximately 3 pounds over the past week, which could further suggest fluid retention. The patient was educated on monitoring her daily weight and recognizing signs of worsening heart failure, such as increased shortness of breath or swelling. This initial assessment provided a baseline for monitoring the patient's response to her current treatment regimen and the effectiveness of lifestyle modifications advised during her last follow-up visit. The findings also prompted consideration for further evaluation by the healthcare team to refine her management plan and prevent progression of heart failure symptoms.

Section 2

As part of the ongoing evaluation, the healthcare team decided to conduct some routine diagnostic tests to gain further insight into the patient's current condition and guide future management strategies. Laboratory results revealed a slightly elevated B-type natriuretic peptide (BNP) level of 180 pg/mL, which is consistent with early-stage heart failure, yet not alarmingly high. This finding confirmed the initial clinical suspicions of fluid retention contributing to the patient's symptoms. Electrolyte levels were within normal limits, with sodium at 138 mEq/L and potassium at 4.2 mEq/L, indicating that the patient’s current medication regimen was effectively maintaining electrolyte balance.

An echocardiogram was performed to assess cardiac function more thoroughly. The results showed a preserved ejection fraction of 55%, confirming that the patient was experiencing heart failure with preserved ejection fraction (HFpEF). There was no evidence of significant heart valve abnormalities or structural changes, suggesting that her heart failure was primarily related to diastolic dysfunction. These findings reinforced the importance of non-pharmacological management, such as dietary modifications and regular physical activity, to help manage symptoms and prevent disease progression.

Based on these diagnostic results, the healthcare team discussed the importance of adhering to a low-sodium diet, engaging in regular, moderate exercise tailored to her capabilities, and maintaining a consistent medication schedule. They also emphasized the importance of regular follow-up appointments to monitor her condition closely. The patient was receptive to this plan and expressed a commitment to making the necessary lifestyle adjustments. By addressing these aspects proactively, the healthcare team aimed to stabilize her condition further and enhance her quality of life.

Section 3

As the patient continued to adhere to the recommended lifestyle changes and medication regimen, the healthcare team scheduled her for a follow-up appointment six weeks later to evaluate her response to the interventions. Upon arrival at the clinic, the patient reported feeling more energetic and noted a reduction in the mild edema she had previously experienced. Her weight had decreased by three pounds, suggesting an improvement in fluid management. During the nursing assessment, her vital signs were stable, with a blood pressure of 128/78 mmHg, a heart rate of 68 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 97% on room air. These findings indicated a positive response to the management plan.

During the follow-up, the healthcare team conducted a repeat BNP test to further assess her heart failure status. The results showed a slight reduction in BNP to 160 pg/mL, reflecting a modest improvement in her cardiac condition. Additionally, her electrolytes remained stable, with sodium and potassium levels consistent with previous results, further affirming the effectiveness of her current treatment plan.

The patient expressed satisfaction with her progress and shared that she had been attending a low-impact exercise class twice a week, which she found enjoyable and beneficial. The healthcare team praised her commitment and reinforced the importance of ongoing adherence to dietary recommendations and exercise. They also scheduled her next follow-up visit in three months, aiming to monitor her status and make any necessary adjustments to her care plan. The team remained optimistic that with continued diligence, the patient could maintain her stability and improve her quality of life, while minimizing the risk of disease progression.

Section 4

Three months later, the patient returned for her follow-up appointment. Upon arrival, she reported feeling generally well, though she noticed occasional mild shortness of breath during activities that required more exertion, such as climbing stairs. She mentioned that her energy levels were still satisfactory, but not quite as high as during her previous visit. During the nursing assessment, her vital signs were recorded as follows: blood pressure at 130/80 mmHg, heart rate of 72 beats per minute, respiratory rate of 20 breaths per minute, and an oxygen saturation of 96% on room air. Her weight had remained stable since the last visit, suggesting continued effective fluid management.

The healthcare team conducted a thorough physical examination and a repeat BNP test. The BNP level was noted to have increased slightly to 180 pg/mL. While this was still within a manageable range, it indicated a need for careful monitoring. Additionally, her electrolyte levels remained stable, with sodium and potassium within normal limits, suggesting that her medication regimen continued to be effective in balancing her electrolytes. The team discussed these findings with the patient, emphasizing the importance of maintaining her current lifestyle changes and medication adherence, while also exploring whether any recent changes in her routine could have influenced her symptoms.

The healthcare team decided to introduce a low-dose diuretic to help manage the occasional breathlessness and prevent potential fluid overload. They also encouraged the patient to monitor her symptoms more closely and to keep a daily log of her weight and any episodes of shortness of breath. The patient was counseled on recognizing early signs of fluid retention, like increased swelling or sudden weight gain, and was advised to contact the clinic if these occurred. With these adjustments, the team aimed to optimize her treatment plan and support her in maintaining stability, while preparing for any potential challenges in the management of her heart failure.

Section 5

Three weeks following the adjustment to her treatment plan, the patient returned to the clinic for a scheduled follow-up appointment. During the visit, she reported feeling a noticeable improvement in her breathing with the addition of the low-dose diuretic. She mentioned that climbing stairs was less strenuous, and she no longer experienced the mild shortness of breath that had been troubling her during physical activity. Her energy levels had also slightly increased, allowing her to engage more comfortably in her daily activities.

On examination, her vital signs were stable: blood pressure was 128/78 mmHg, heart rate was 70 beats per minute, respiratory rate was 18 breaths per minute, and oxygen saturation remained at 97% on room air. Her weight had decreased by two pounds since the last visit, indicating effective fluid management. The nursing assessment revealed no signs of edema or jugular vein distension, and lung auscultation showed clear breath sounds bilaterally, suggesting the absence of fluid accumulation.

The healthcare team reviewed her daily weight and symptom log, which demonstrated consistent weight and minimal episodes of breathlessness. Encouraged by these findings, the team decided to continue the current regimen, reinforcing the importance of medication adherence and lifestyle modifications. The patient was advised to maintain her monitoring routine and was scheduled for another follow-up in three months, with instructions to report any significant changes in her condition immediately. These positive responses to the interventions provided reassurance of the ongoing stability in her heart failure management.