Based on Mrs. Johnson's assessment findings, which intervention is most important for the nurse to include in her care plan to manage her congestive heart failure symptoms?

C) Educate on reducing sodium intake to help manage fluid overload.

A) Encourage increased fluid intake to prevent dehydration.

B) Recommend high-protein snacks to boost energy levels.

C) Educate on reducing sodium intake to help manage fluid overload.

D) Advise on performing high-intensity exercises to improve cardiac function.

Which of the following nursing interventions is most appropriate for a patient like Mrs. Johnson who exhibits signs of mild fluid overload due to early-stage congestive heart failure?

A) Encourage increased fluid intake

C) Recommend daily vigorous exercise

What is the primary reason for instructing Mrs. Johnson to adhere to a low-sodium diet in managing her condition?

B) To decrease fluid retention and edema

A) To reduce the risk of developing hypertension

B) To decrease fluid retention and edema

C) To enhance the absorption of her medications

D) To improve her energy levels through better nutrition

What does the nurse's observation of decreased jugular venous distention and minimal crackles in Mrs. Johnson's lung bases indicate about her heart failure management?

B) Her heart failure is improving.

A) Her heart failure is worsening.

B) Her heart failure is improving.

C) Her heart failure is unchanged.

D) Her heart failure management is ineffective.

What is the primary reason Mrs. Johnson's weight remains stable despite her heart condition?

B) She is adhering to a low-sodium diet.

A) She has increased her physical activity significantly.

B) She is adhering to a low-sodium diet.

C) She is taking her diuretics as prescribed.

D) She is sleeping better and feels more energetic.

Which of the following symptoms should Mrs. Johnson report immediately to her healthcare provider?

C) Increased shortness of breath

During Mrs. Johnson's follow-up visit, the nurse observes an increase in jugular venous distention and more pronounced crackles at the lung bases. Which nursing intervention should the nurse prioritize based on these findings?

B) Review and adjust diuretic dosage with the healthcare provider

A) Encourage increased fluid intake

B) Review and adjust diuretic dosage with the healthcare provider

C) Advise Mrs. Johnson to reduce her physical activity

D) Instruct Mrs. Johnson to increase her dietary sodium

What is the most appropriate nursing intervention for Mrs. Johnson to prevent episodes of lightheadedness when rising from a seated position?

C) Instruct her to stand up slowly and cautiously

A) Encourage her to perform leg exercises before standing

B) Advise her to increase her diuretic dosage

C) Instruct her to stand up slowly and cautiously

D) Suggest she decrease her fluid intake

What is the most appropriate nursing intervention to prevent orthostatic hypotension in Mrs. Johnson?

A) Encourage Mrs. Johnson to perform leg exercises before standing.

B) Advise Mrs. Johnson to increase her sodium intake.

C) Suggest Mrs. Johnson take her diuretics at night.

D) Instruct Mrs. Johnson to avoid physical activity.

congestive heart failure - Nursing Case Study

Pathophysiology

• Primary mechanism: The heart's pumping ability weakens, often due to damage like a heart attack or high blood pressure, causing it to be less effective at pushing blood out to the body. This leads to fluid buildup as the body tries to compensate for reduced circulation.

• Secondary mechanism: The kidneys, sensing less blood flow, retain sodium and water, which further increases blood volume. This adds strain on the heart and worsens the fluid buildup, leading to congestion in lungs and tissues.

• Key complication: Fluid accumulation in the lungs (pulmonary edema) causes breathing difficulties and reduces oxygen delivery to the body, exacerbating heart failure symptoms and impacting quality of life.

Patient Profile

Demographics:

65-year-old female, retired school teacher

History:

• Key past medical history: Hypertension, Type 2 Diabetes

• Current medications: Lisinopril, Metformin, Aspirin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Mild shortness of breath on exertion

• Key symptoms: Occasional fatigue, slight swelling in ankles

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

Section 1

Initial Assessment Findings:

Upon further assessment, the nurse notes that the patient, Mrs. Johnson, exhibits mild jugular venous distention, indicating potential fluid overload. Auscultation of the lungs reveals faint bilateral crackles at the bases, suggesting the presence of some pulmonary congestion. The patient reports an increase in her mild shortness of breath when climbing stairs, a new development over the past three weeks. Her daily activities have been slightly impacted, as she tires more easily than before.

The nurse also performs a thorough inspection of Mrs. Johnson's lower extremities and notes 1+ pitting edema in both ankles, which confirms the slight swelling the patient previously mentioned. Her skin appears warm and dry, with no signs of cyanosis or clubbing in the fingers, indicating adequate peripheral perfusion at this time. All peripheral pulses are present and palpable.

These findings suggest that Mrs. Johnson's congestive heart failure, although in the early stages, is beginning to affect her daily life more noticeably. The nurse recognizes the importance of monitoring her condition closely and evaluating the effectiveness of her current medication regimen. Adjustments may be needed to prevent progression. Education on lifestyle modifications, such as dietary changes to reduce sodium intake and the importance of adhering to her medication schedule, will be crucial components of her ongoing care plan.

Section 2

The nurse decides to focus on Mrs. Johnson's response to interventions, particularly the lifestyle modifications and medication adherence. Over the next two weeks, the patient is encouraged to strictly follow a low-sodium diet, as well as to keep a daily record of her weight to monitor fluid retention. Mrs. Johnson is also educated on the importance of taking her prescribed diuretics and ACE inhibitors consistently. The nurse schedules a follow-up appointment to reassess Mrs. Johnson's condition and the effectiveness of these interventions.

At the follow-up visit, Mrs. Johnson reports that she has been diligent in adhering to her new diet and medication regimen. She notes a slight improvement in her energy levels and a reduction in the frequency of shortness of breath when performing daily activities. The nurse conducts a reassessment and finds that the jugular venous distention is less pronounced, and the crackles in the lung bases have diminished slightly. However, the 1+ pitting edema in her ankles remains unchanged. Her vital signs are stable, with a blood pressure of 128/78 mmHg and a regular heart rate of 72 beats per minute.

Lab results from recent tests show a slight improvement in her serum electrolytes, with sodium levels within the normal range, indicating positive dietary changes. The nurse discusses these findings with Mrs. Johnson, emphasizing the importance of continuing her current treatment plan. The nurse also highlights the need for ongoing monitoring to detect any potential complications early. Mrs. Johnson feels encouraged by the progress and agrees to maintain her current lifestyle modifications, understanding that managing her condition is a gradual process.

Section 3

Two weeks after the follow-up visit, Mrs. Johnson returns to the clinic for another assessment. This time, she reports feeling more energetic and has been able to participate in light gardening, an activity she enjoys, without experiencing significant shortness of breath. She has been consistent with her low-sodium diet and medication regimen, diligently recording her daily weight. Her weight has remained stable, with no significant fluctuations, suggesting effective management of fluid retention. She also mentions that she has been sleeping better at night, with fewer instances of waking up short of breath.

Upon examination, the nurse notes that Mrs. Johnson's jugular venous distention has further decreased, and the crackles in her lung bases are now minimal. Her 1+ pitting edema in the ankles persists, but there is a slight improvement noted. Vital signs show a blood pressure of 126/76 mmHg and a heart rate of 70 beats per minute, both of which are within her target range. Recent lab results indicate that her serum potassium is stable, an important consideration given her diuretic use. Furthermore, her renal function tests remain within normal limits, indicating that her body is handling the medication well.

Encouraged by these positive changes, the nurse reinforces the importance of Mrs. Johnson's continued adherence to her treatment plan and lifestyle modifications. They discuss the potential for gradually increasing physical activity as tolerated, to further enhance cardiovascular health. The nurse also advises Mrs. Johnson to remain vigilant for any signs of worsening symptoms, such as increased shortness of breath or rapid weight gain, and to seek medical advice promptly if these occur. Mrs. Johnson is reassured by her progress and expresses a strong commitment to maintaining her health improvements, understanding that her proactive approach is key to managing her condition effectively.

Section 4

Two months later, Mrs. Johnson returns for a routine follow-up visit. During this appointment, she reports feeling slightly more fatigued than usual but attributes it to a busy week of family activities. Although she has been able to maintain her low-sodium diet and continues to monitor her daily weight, she notes a slight increase of two pounds over the past week. Despite the busy schedule, she has managed to incorporate gentle walks into her routine, although she finds herself needing to rest more frequently.

Upon assessment, the nurse detects a mild increase in jugular venous distention compared to the previous visit, and the crackles at the lung bases, while still minimal, are slightly more pronounced. Mrs. Johnson's vital signs reveal a blood pressure of 130/78 mmHg and a heart rate of 74 beats per minute, which remain within acceptable limits. However, the 1+ pitting edema in her ankles has not improved since the last visit. Recent lab tests indicate a slight decrease in renal function, with serum creatinine elevated just above the normal range, prompting the nurse to consider the impact of her diuretic therapy.

The nurse discusses these findings with Mrs. Johnson, emphasizing the importance of continued monitoring and potential adjustments to her medication regimen. They explore strategies to manage her fluid balance more effectively, such as slightly increasing her diuretic dosage under medical supervision. Mrs. Johnson is reminded to watch for any further signs of fluid retention or increased fatigue, and to report these promptly. The nurse also reassures her that these minor fluctuations are not uncommon and reinforces her ability to manage them with continued vigilance and adherence to her treatment plan.

Section 5

Three weeks later, Mrs. Johnson returns for another follow-up appointment. During this visit, she reports feeling slightly better after the minor adjustment in her diuretic dosage. She has been diligent in adhering to her low-sodium diet and has successfully integrated brief, regular walks into her daily routine, now with less frequent rests required. However, Mrs. Johnson mentions occasional lightheadedness when rising from a seated position, which she attributes to her increased activity level.

During the assessment, the nurse observes a reduction in jugular venous distention and notes that the crackles at the lung bases have diminished slightly, suggesting some improvement in fluid status. Mrs. Johnson's vital signs reveal a blood pressure of 128/76 mmHg and a heart rate of 72 beats per minute, indicating stability. The 1+ pitting edema in her ankles persists, but there is no further increase, which the nurse finds reassuring. Recent lab results show a slight improvement in her renal function, with serum creatinine levels returning to within normal limits, suggesting a positive response to the adjusted diuretic regimen.

The nurse discusses these findings with Mrs. Johnson, highlighting the importance of monitoring her blood pressure and watching for signs of orthostatic hypotension, given her occasional lightheadedness. They review strategies to help prevent these episodes, including standing up slowly and staying well-hydrated. Mrs. Johnson is encouraged by the improvements and reassured that continued adherence to her treatment plan is key to managing her condition effectively. The nurse and Mrs. Johnson agree to maintain close monitoring of her symptoms and to schedule another follow-up appointment in one month to ensure her heart failure remains well-controlled.