Acute exacerbation of CHF2 Flashcards
What is the likely diagnosis for a patient who has a history of congestive heart failure and presents with shortness of breath? What are the expected abnormal vital signs?
Acute decompensation heart failure; high blood pressure and high respiratory rate
How do patients with CHF exacerbation present?
Months of progressive increasing shortness of breath that has acutely worsened over the last day or so, now experiences SOB at rest. Symptoms are relieved when patient sits up right. Mild cough with deep inspiration with occasional pink frothy sputum. Weight gain, easy fatigability, leg swelling, decreased appetite
How does the cough present in acute decompensation heart failure?
Mild cough with deep inspiration, pink frothy sputum
What are the best medical history pertinent positives for CHF?
Hypertension, diabetes, hypercholesterolemia, history of myocardial infarction, Smoker
What is the initial approach for this patient?
Elevated bed, pulse ox, oxygen inhalation, IV access, cardiac monitor, 12 lead ECG.
What are the pertinent positives for physical examination in a cutie conversation heart failure?
Mild respiratory distress, JVD, bilateral decreased breath sounds with bibasilar crackles, As 3 gallon, right upper quadrant tenderness, liver 1 cm below the right cost of margin, 3+ bilateral pitting Edema up to the knee
What is the most likely cause for acute decompensated heart failure?
Assuming patient is taking their medications, high sodium intake from dietary noncompliance
What should be ordered for this patient?
Chest x-ray PA and lateral views, CBC with differential, BMP, Troponin I stat and Q6 times two, LFTs, NT-pro BNP
After the initial orders are ran, what orders should be done?
Admit to the ward, telemetry, ambulate at will, low sodium, low cholesterol, diabetic diet, inputs and output monitoring, restrict fluids, daily weights
What how medication should be discontinued in this particular patient?
Glyburide;
Which should be given to this patient?
Insulin sliding scale, 10 units of regular insulin rn, potassium chloride as long as the Lasix is given, Lovenox
What can transthoracic echo cardio gram show and this patient?
Left ventricular hypertrophy you, left ventricular ejection fraction of 40%, abnormal diastolic function, normal valves (HFDV)
Explain the mode of administration of diuretics and CHF patients?
IV to oral, to prepare for discharge
How can we tell if this patient is prepared for discharge?
Improved dyspnea and peripheral Edema
What is the goal for oxygen therapy? At what point should the therapy be stopped?
Go saturation is 92% to 96%. Wean oxygen and pulse oxygen saturation is greater than 92%
