Mrs. S.A is a 96-year-old female who came to the Emergency unit from home with sudden acute decompensation of shortness of breath and peripheral pitting edema +4 in both legs. Upon arriving at the ER the patient’s vital signs were assessed with a blood pressure of 150/79, HR- 100, O2 saturation of 77% in room air, restless, heart sounds grade 2 murmurs, bilateral wheezing on expiration and inspiration.
The diagnostics tests result was congested heart failure associated with cardiomegaly secondary to the accumulation of fluid on the right side of the lungs. She was treated with oxygen therapy and pain medication to improve oxygenation, nitroglycerin IV to decrease preload of the heart and diuretics to decrease intravascular volume (Lewis et al., 2019, p. 935).
According to the patient’s chart, she was also admitted to Sunnybrook three weeks ago before due to heart failure related to pneumonia. She was treated with ceftriaxone and azithromycin then amoxicillin for seven days. During the stay, the patient had issues about delirium and refused to drink and eat. There were concerns about dysphasia and the risk of aspiration. After being treated, she was discharged home. But about a week after the discharge as the patient ambulances at home she developed a sudden discomfort of breathlessness and was sent to the emergency unit.
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She was admitted to the cardiology unit last February 7, 2020, with admitting diagnosis of congestive heart failure. Heart failure is a clinical syndrome characterized by inadequate systemic perfusion to meet the body’s metabolic demands (Huether et al., 2018, p1175). It is a significant prevalence in older people, commonly caused by the history of ischemic heart disease, prolonged hypertension, arrhythmias and valve disorders.
It is divided into two types, right and left-sided heart failure, but it frequently biventricular. The left-sided heart failure also known as systolic dysfunction results from the inability of the heart to pump blood causing blood backflow through the left atrium and into the pulmonary veins. This increase in pulmonary pressure causes fluid leaking into the interstitium and alveoli which manifest the patient’s pulmonary congestion (Huether et al., 2018, p.1176).
While the right-sided heart failure also known as diastolic dysfunction results from the impaired filling or relaxation of the diastolic which causes blood backflow into the right atrium and venous circulation which was manifested by the patients signs and symptoms of peripheral edema, fatigue, pulmonary congestion, pulmonary hypertension and ventricular hypertrophy (Lewis et al., 2019, p. 930).
Because of this, my main concern for this patient is the risk for complications of decreased cardiac output, ineffective breathing patterns, and excessive fluid volume that can lead to cardiogenic or hypovolemic shock. My other main concerns were patients’ unsteady gait related to her spinal stenosis and weakness in lower extremities that increase her risk for falls. Lastly, family and caregiver health teaching on how to prevent having a recurrent episode of heart failure exacerbation.
