JoAnn Smith _ Heart_Failure-SKINNY_Reasoning (1) | RNSG 2022 _ Recognizing RELEVANT Clinical Data

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RNSG 2022 Heart_Failure-SKINNY_Reasoning (1) Part I: Recognizing RELEVANT Clinical Data History of Present Problem: JoAnn Smith is a 72-year-old woman who has a history of myocardial infa... rction (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 She has struggled with depression the past two years and has been more withdrawn since her husband of 52 years died unexpectedly three months ago from a myocardial infarction.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: -Ms. Smith’s history of myocardial infarction (MI) from four years ago and systolic heart failure secondary to ischemic cardiomyopathy. -She came into the ER for SOB the past 3 days which has now went from SOB during activity to SOB at rest. -The only way she has been able to rest comfortably is by sleeping upright in her recliner. She can only speak partial sentences before having to take a breath in order to have a conversation with the nurse. -Increased swelling in the lower legs and a weight gain of 6 pounds in the past 3 days. -A current ejection fraction (EF) of only 15% supports the indication of heart failure. Anything less than 45-55% supports this claim. -Left-sided heart failure is most likely what is causing the pulmonary edema. The fluid being trapped is affecting her breathing resulting in the SOB. -Orthopnea is often associated with the progression of left-sided heart failure. -Edema is present here. This is an indicator that left-sided heart failure is beginning to affect the right side. RELEVANT Data from Social History: Clinical Significance: -JoAnn can no longer tolerate the level of activity she’s used to due to dealing with the progression of her heart failure for the past two years. -The fact that she has been battling depression over the past two years and losing her husband not too long ago has caused her to withdraw even more. -Her activity intolerance is secondary to the progression of heart failure. -The death of her husband added to her inability to effectively cope with and find ways to overcome her depression. Instead, it caused her to push back even further. - - - - - - - -- - - - - - - - CARING/COMFORT: How can you engage and show that this pt. matters to you? - Clients with this disease process need support to have the best quality of life and comfort. Client care can be offered along with medical interventions or might be the only treatment given based on the client’s decision. It is important to allow the client to voice their opinion and be educated on different avenues in regard to combating an illness. They have the right to be directly involved and collaborate with the healthcare team in regard to decisions made. Physical comfort measures: - Assess client’s pain and its characteristics at least every 2 hours while awake and 30 minutes after implementing a pain management technique. Also, Determine client’s choice for pain relief techniques from among those available. -Breathing exercises -Massages - Promote laughter by suggesting that client relate a humorous story or watch a video or comedy of his or her choice. - Quick interventions prevent or minimize pain. Encouraging and respect client’s participation in decision making. Suffering contributes to the pain experience and can be reduced by eliminating delays in nursing response. - Breathing aids in anxiety relief - Massage promotes the release of endorphins and enkephalins that moderate the sensation. - Laughter promote a feeling of well-being. -Helps to make a more accurate diagnosis, and thus establish the most beneficial treatment plan for patients presenting with pain. -The client’s stress and anxiety will be decreased and they will be more adherent to health promotion aids -Helps to mitigate pain, increase comfort, and preserve function of all major body systems. - Laughter can help lessen depression and anxiety and may make the client feel happier. EMOTIONAL SUPPORT: Principles to develop a therapeutic relationship Being patient and allowing the client to be able to speak/voice their feelings while practicing effective listening skills. Offering pen and paper as an alternative and they cannot fully gather their thoughts. This allows the nurse and the client identify underlying issues/struggles the client may be dealing with. One’s thoughts and feelings often time accounts for so many personal obstacles. Talking with someone else about it may help an individual cope better and find ways to deal with situations in a positive manner. Help the client determine the cause of emotional issues and erase the feeling of depression and not knowing how to carry on. SPIRITUAL CARE/SUPPORT: Engage in conversations with the client about various life situations and offer guidance to help lead the client to a better lifestyle. This shows the client that they have the support of the nurse which can lead to a sense of the client feeling more comfortable with opening about who they are and feeling accepted. When you show acceptance towards an individual that warrants positive communication and the feeling of comfort on their end when talking about their emotional needs. A positive nurse-client relationship helps the client be more at ease and be more willing to utilize help resources. 5. What educational/discharge priorities need to be addressed to promote health and wellness for this patient and/or family? (Health Promotion and Maintenance) Heart failure can often be managed at home. Monitoring sodium and practicing a sodium-restricted diet, lifestyle changes, and prescribed medications are often involved in the treatment of heart failure. The main goal is to promote oxygenation and improve the heart’s ability to eject blood efficiently. Fluid volume excess should be monitored, and activities arranged should be within the client’s physical limitations. Lastly, providing support to the client and their family is equally important. [Show More]

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