CASE STUDY

Mr. SM, a 60-year-old married male is a retiree public school teacher, noticed

that he felt tired a lot lately stating “Napapadalas akong hinahapo kahit konti lang yung

ginagawa ko, two weeks ko na ito nararamdaman. He was admitted to the hospital

accompanied by his daughter. He is 100kg at a height of 180cm so his calculated body

mass index (BMI) was 30.9 indicating that he was overweight. Besides, he also

experienced orthopnea, fatigue, paroxysmal nocturnal dyspnea and leg swelling up to

his thigh. Mr. SM was admitted to the hospital for to the same problem last year.

The nurse assessed Mr. SM and noted to be alert and conscious but he was

having pedal edema up to his knee. Besides, the patient was noted with bibasal

crepitations with no rhonchi. His body temperature was normal. However, his blood

pressure was found to be elevated upon admission with a record of 159/100 mmHg with

an irregular pulse rate at 85beats/min.

Mr. SM had known case of heart failure in the last 3 years ago and he had also

diagnosed with hypertension for 5 years. Before admitted to the hospital, patient was

taking frusemide 40mg, aspirin 150mg, metoprolol 50mg, amlodipine 10mg, and

simvastatin 40mg for his hypertension and heart failure. Patient does not allergic to any

medication and he does not take any traditional medicines at home. His family history

revealed that his father had died of ischemic heart disease 4 years ago while his brother

has hypertension. As for his social history, he smokes 2-3 cigarettes a day for 35 years

and the calculated smoking pack years was 5 pack years. Besides, Mr. SB also drinks

occasionally.

Physical Examination reveals:

Vital signs:

BP: 159/100mmhg
T: 36.8 degree Centigrade

PR: 85 BPM

RR: 25 BPM

Weight: 100 Kg

Height: 180 cm

Crackles at the base of the lungs

Bipedal Edema grade 2+

Muscle Strength of 4/5 on both lower extremities

Admitting Diagnosis: Class III Heart Failure

DIAGNOSTIC TESTS

Cardiac markers

 BNP: 453pg/mL Troponin (+)

 ECG: T-wave inversion. INR was 1.04 which was lower than normal while APTT was
found to be slightly higher (59.4 seconds). 
 2D Echo – waiting for results
 BUN - within normal limits
 Creatinine - 143µmol/L
 CBC –
RBC- 4.8/ mcL
WBC- 9,000/ mcL
Platelet count- 320,000/ mcL
 Sodium- 139 mEq
 Potassium- 3.5 mEq
 FBS- 7 mmol/L
 HbAIC- 6.5 %
 Lipid profile, Uric acid- within normal range
 Chest Xray – Cardiomegaly with right and left ventricular hypertrophy, fluid in

lower lung fields.

Course in the ward:

Mr. SM was diagnosed with congestive heart failure (CHF) with fluid overload.

The patient also suffered from hypertension. The management plan included

intraveneous frusemide 40mg twice daily, aspirin 150mg once daily, simvastatin 40mg
once at night and ramipril 2.5mg once a day. Besides, patient was asked to restrict his

fluid intake to 500ml per day and oxygen therapy was given to patient at high flow using

a face mask when patient experiencing shortness of breath.

As for his clinical progression, on day 1, the patient was complained of shortness

of breath, leg swelling and orthopnea. Enchocardiogram showed that he had

cardiomegaly. Treatment of CHF was given. Throughout the stay in the hospital, Mr. SB

had responded well to the heart failure therapy as there was no more complaint of chest

pain or shortness of breath on day 13 and his pedal oedema had gradually improved.

However, patient’s blood pressure throughout day 1 to 9 was fluctuating between the

range of 102/67-160/100 mmHg and therefore, hypertension treatment was given and

blood pressure on day 10 onwards had been seen fell within the normal range.

Furthermore, Mr. SM’s renal function became progressively worse from 143µmol/L on

admission to 175µmol/L on day 11 and the calculated creatinine clearance on day 11

was 56.2ml/min.
 I. PATIENT PROFILE
Age: 60 years old Sex: Male

Marital status: Married Occupation: Retired public school teacher

Medical Diagnosis: Congestive heart failure (CHF) with fluid overload

Attending Physician:

Type of Operation (if any): N/A

Date & Time of Operation: N/A

II. MEDICAL HISTORY

1. PRESENT NURSING HISTORY

 Prior consultation, Mr. SM noticed that he felt tired a lot lately, he was overweight and
also experiencing orthopnea, fatigue, paroxysmal nocturnal dyspnea and leg swelling
up to his thigh. Upon medical assessment, he was noted having pedal edema up to
his knees and noted with bibasal crepitation with no ronchi and his blood pressure
was elevated with a record of 159/100mmhg with an irregular pulse rate 85 bpm. And
upon medical examination, he was diagnosed with congestive heart failure with fluid
overload and he also suffered from hypertension and on plan medication include
intravenous furosemide 40mg BID, aspirin 150mg OD, simvastatin 40mg QHS, and
ramipril 2.5mg OD. And he was asked to restrict his fluid intake to 500ml per day and
oxygen therapy was given to patient at high flow using a face mask when patient
experiencing shortness of breath.

2. PAST NURSING HISTORY

 Prior to his present condition, Mr. SM had known case of heart failure 3 years ago,
and also diagnosed with hypertension 5 years ago, and was taking furosemide 40mg,
aspirin 150mg, metoprolol 50mg, amlodipine 10mg, and simvastatin 40mg for his
hypertension and heart failure. He is not allergic to any medication and not taking any
 traditional medicine at home. His family history revealed that his father had died of
ischemic heart disease 4 years ago while his brother has hypertension. And as for his
social history, he smokes 2-3 cigarretes a day for 35 years and the calculated
smoking pack years was 5 pack years. Besides, Mr. SB also drinks occasionally.

III. LABORATORY AND DIAGNOSTIC PROCEDURE

DETERMINATION RESULT NORMAL VALUE CLINICAL SIGNIFICANT

Cardiac markers

 BNP (B-  453pg/mL  Less than 100  BNP level is a strong
type Troponin (+) pg/mL. predictor of risk of
death and
natriuretic
cardiovascular
peptide )
events in patients
previously diagnosed
with heart failure or
cardiac dysfunction.
It also can aid in
differentiating cardiac
from noncardiac
causes of dyspnea in
patients with
ambiguous
presentations. BNP
is an independent
predictor of
increased left
ventricular end-
diastolic pressure,
and it is used for
assessing mortality
risk in patients with
heart failure
 ECG  T-wave  Normal ECG   It gives a graphical
inversion. INR values for waves representation of the
was 1.04 which and intervals are electrical activity of
was lower than as follows: the heart during a
normal while   RR interval: 0.6- cardiac cycle which
APTT was 1.2 seconds. helps to further
found to be   P wave: 80 detect the
slightly higher milliseconds. abnormalities and
(59.4 seconds).  PR interval: 120- help us to measure
200 milliseconds. the functioning of the
heart.
  Electrocardiography
(ECG) is useful for
identifying other
causes in patients
with suspected heart
failure.
 BUN (Blood  Within normal  Around 6 to 24  A common blood
Urea limits mg/dL (2.1 to 8.5 test, the blood urea
Nitrogen) mmol/ ) nitrogen (BUN) test
reveals important
information about
how well the kidneys
are working. A BUN
test measures the
amount of urea
nitrogen that's in the
blood.

 Creatinine  143µmol/L   0.7 to 1.3 mg/dL  Creatinine has been

(61.9 to 114.9 found to be a fairly
µmol/L) for reliable indicator of
men and 0.6 to 1.1 kidney function.
mg/dL (53 to 97.2 Elevated creatinine
µmol/L) for level signifies
women. impaired kidney
function or kidney
disease. As the
kidneys become
impaired for any
reason, the
creatinine level in the
blood will rise due to
poor clearance of
creatinine by the
kidneys.
 CBC  RBC 4.8/ mcL  Male: 4.35-5.65   A complete blood
(Complete count (CBC) is a
trillion cells/L blood test used to
blood
(4.35-5.65 million evaluate overall
count )
cells/mcL) health and detect a
wide range of
 Female: 3.92-5.13
disorders, including
trillion cells/L anemia, infection and
(3.92-5.13 million leukemia.
cells/mcL)

 WBC- 9,000/  3.4-9.6 billion

mcL cells/L
(3,400 to 9,600
cells/mcL)

 Platelet count-
 Male: 135-317
320,000/ mcL
billion/L
(135,000 to
317,000/mcL)
 Female: 157-371
billion/L
(157,000 to
371,000/mcL)

 Sodium  139 mEq  Between 135 and  It checks how much

sodium is in the
145 blood. Sodium is
milliequivalents both an electrolyte
per liter (mEq/L). and mineral. It helps
keep the water (the
amount of fluid inside
and outside the
body's cells) and
electrolyte balance of
the body. Sodium is
also important in how
nerves and muscles
work. Serum sodium
levels have
prognostic value as
 predictors of
mortality in patients
with chronic HF.
They also play a role
in the prediction of
short-term mortality
for patients admitted
with decompensated
heart failure.
 Potassium  3.5 mEq  3.6 to 5.2  Used to monitor
or diagnose
millimoles per conditions related to
liter (mmol/L). abnormal potassium
levels. These
conditions include
kidney disease, high
blood pressure, and
heart disease.

 FBS  7 mmol/L   Less than 100   Measures blood

(Fasting sugar after an
mg/dL (5.6 overnight fast (not
blood
mmol/L) eating)
sugar )

 HbAIC  6.5 %  Between 4% and   Blood test that is

used to help
5.6% diagnose and
monitor people with
diabetes. It is also
sometimes called a
haemoglobin A1c,
glycated
haemoglobin or
glycosylated
haemoglobin. HbA1c
refers to glucose and
haemoglobin joined
together (the
haemoglobin is
'glycated').

 Lipid profile  within normal  Less than 150  Lipid profile blood
range. mg/dL test is measures
lipids—fats and fatty
substances used as
 a source of energy
by your body.

 Uric acid
 Uric acid test is
checks how much
 Adult male: 4.0- uric acid is in the
8.5 mg/dL or 0.24- urine.
0.51 mmol/L. Adult
female: 2.7-7.3
mg/dL or 0.16-
0.43 mmol/L

 Chest Xray  Cardiomegaly  The shadows on a  Chest radiographs

with right and chest X-ray test are used to assess
left ventricular depend on the the degree of
hypertrophy, degree of pulmonary
absorbed radiation congestion and
fluid in lower
by the particular cardiac contour (to
lung fields.
organ based on its determine the
composition. ony presence of
structures absorb cardiomegaly).
the most radiation
and appear white
on the film. Hollow
structures
containing mostly
air, such as
the lungs,
normally appear
dark. In a normal
chest X-ray, the
chest cavity is
outlined on each
side by the white
bony structures
that represent the
ribs of the chest
wall. On the top
portion of the
chest are the neck
and the collar
bones (clavicles).
On the bottom, the
chest cavity is
bordered by the
diaphragm under
which is the
abdominal cavity.
On either side of
the chest wall, the
bones of the
shoulders and
arms are easily
recognizable.
Inside the chest
cavity, the
vertebral column
can be seen down
the middle of the
chest, splitting it
nearly in equal
halves. On each
side of the midline,
the dark appearing
lung fields are
seen. The white
shadow of the
heart is in the
middle of the field,
atop the
diaphragm, and
more to the left
side. The trachea
(windpipe), aorta
(main blood vessel
exiting the heart),
and
the esophagus de
scend down the
middle,
overlapping the
vertebral column.
IV. DRUG STUDY

Brand Name: Mechanism of Indication: Nursing

 Lasix Action:  Acute Responsibilities
Pulmonary
 A potent drug Edema  Monitor weight,
that inhibits  Edema due to blood pressure
Generic Name: sodium and heart failure, and pulse rate
 Furosemide chloride hepatic routinely.
reabsorption impairment, or  Monitor fluid
at the renal disease. intake, output
proximal and  Hypertension and electrolytes,
Dosage: (actual distal tubules BUN, and
dosage the patient is and the carbon dioxide
taking) ascending level frequently.
loop of henle.  Watch for signs
 40 mg Contraindication: of hypokalemia
Side effect/Adverse such as muscle
Route:  Contraindicate
Reaction: weaknesses and
 P.O in patient
 I.V cramps.
 CNS; vertigo, hypersensitive  Monitor glucose
headache, to drugs and in level in diabetic
Frequency: those with
dizziness, patients.
paresthesia, anuria.  Monitor uric acid
 Twice daily
weakness, level, especially
Classification: restlessness, in patient with a
fever. history of gout.
 Loop diuretics  CV;  Monitor elderly
orthostatic patient who are
hypotension, especially
thrombophlebi susceptible to
tis with I.V excessive
administration. diuresis,
 EENT; because
transient circulatory
deafness, collapse and
blurred or thromboembolic
yellowed complication are
vision, possible.
tinnitus.
 GI; abdominal
discomfort,
and pain,
diarrhea,
anorexia,
nausea,
vomiting,
constipation,
pancreatitis.
 GU; nocturia,
 polyuria,
frequent
urination,
oliguria.
 Hematologic;
agranulocytosi
s, aplastic
anemia,
leukopenia,
thrombocytop
enia,
azotemia,
anemia.
 Hepatic;
hepatic
dysfunction,
jaundice.
 Metabolic;
volume
depletion and
dehydration,
asymptomatic
hyperuricemia
, impaired
glucose
tolerance,
hypokalemia,
hypochloremic
alkalosi,
hyperglycemia
, dilutional
hyponatremia,
hypocalcemia,
hypomagnese
mia.
 Musculoskel
etal; muscle
spasm.
 Skin;
dermatitis,
purpura,
photosensitivit
y reaction,
transient pain
at I.M injection
site.
 Other; gout
Brand Name: Mechanism of Action: Indication: Nursing
Responsibilitie
 Bayer Aspirin  Through to  Rheumatoid s
produce arthritis,
analgesia by osteoarthritis, or  For
Generic Name: inhibiting other inflammat
prostaglandin and polyarthritis or ory
 Acetylsalicylic other substances inflammatory condition
acid that sensitize pain condition. s,
receptors. Drug  Mild pain or rheumatic
may relieve fever fever. fever and
Dosage: (actual by acting on the  To prevent thrombosi
dosage the patient hypothalamic thrombosis. s, give
is taking) heat-regulating  To reduce risk aspirin on
 150 mg center and may of MI in patients a
exert its anti- with previous MI schedule
Route: inflammatory or unstable rather
 P.O effect by inhibiting angina. than as
 P.R prostaglandin and  Kawasaki needed.
other substances. syndrome  For
Frequency: In low doses, (mucocutaneou patient
 Once daily drug also appears s lymph node with
to interfere with syndrome) swallowin
Classification: clotting by  Acute rheumatic g
 Salicylate, keeping a fever. difficulties
NSAID platelet-  To reduce risk , crush
aggregating of recurrent non-
substance from transient enteric
forming. ischemic coated
attacks and aspirin
stroke or death and
Side effect/Adverse in patient at risk. dissolve
Reaction:  Acute ischemic in soft
stroke. food or
 EENT; tinnitus,  Acute liquid.
hearing loss. pericarditis after Give
 GI; nausea, GI MI. liquid
bleeding, immediat
dyspepsia, GI ely after
distress, occult Contraindication: mixing
bleeding. because
 HEMATOLOGIC;  Contraindicated drug will
prolonged in patients break
bleeding time, hypersensitive down
leukopenia, to drugs and rapidly.
thrombocytopenia those with  For
. NSAID-induced patient
 HEPATIC; sensitivity who can’t
hepatitis reaction. G6PD tolerate
 SKIN; rash, deficiency, or oral
 bruising, urticaria bleeding drugs,
 Other; disorder, such ask
angioedema, reye as haemophilia, prescriber
syndrome, von willebrand about
hypersensitivity disease or using
reaction. telangiectasia. aspirin
 rectal
supposito
ries.
Watch for
rectal
mocusal
irritation
or
bleeding.
 Monitor
elderly
patient
closely
because
they may
be more
susceptibl
e to
aspirin
toxic
effect.
 Drug
irreversibl
y inhibits
platelet
aggregati
on. Stop
5-7 days
before
elective
surgery to
allow time
for
productio
n and
release of
new
platelets.
 Monitor
patient for
hypersen
sitivity
reaction
such as
anaphyla
xis and
asthma.
Brand Name: Mechanism of Indication: Nursing
Action: Responsibilities
 Lopressor  A selective beta  Metoprolol is
blocker that indicated for the  Always
selectively treatment of check
Generic Name: blocks beta angina, heart patient’s
receptors; failure, myocardial apical
 Metoprolol decrease infarction, atrial pulse rate
cardiac output, fibrillation, atrial before
peripheral flutter and giving
resistance, and hypertension. drug. If it’s
Dosage: (actual
cardiac oxygen slower
dosage the patient
consumption; tham
is taking) Contraindication:
and depresses 60bpm,
 50 mg renin secretion. withhold
 Contraindicated in drug and
patients call
Side effect/Adverse hypersensitivity to prescriber
Route:
Reaction: drugs or other immediate
 P.O beta blockers. ly.
 I.V  CNS; fatigue,  Contraindicated in  In diabetic
dizziness, patients with sinus patient,
Frequency: depression. bradycardia, monitor
 CV; greater than first- glucose
 Twice daily hypotension, degree heart level
bradycardia, block, cardiogenic closely
Classification: heart failure, AV shock, or overt because
block, edema. cardiac failure drug
 Beta blocker  GI; nausea, when used to treat masks
diarrhea hypertension or common
 Respiratory; angina. signs and
dyspnea  When used to symptoms
 Skin; rash treat MI of
(myocardial hypoglyce
infarction), drug is mia.
contraindicated in  Monitor
patient with heart blood
rate less than 45 pressure
bpm, greater than frequently
first-degre heart because
block, PR interval drug
of 0.24 seconds or masks
longer with first- common
degree heart block signs and
, systolic blood symptoms
pressure less than of shock.
100mmHg or
moderate to
severe cardiac
failure.
Brand Name: Mechanism of Indication: Nursing
 Norvasc Action: Responsibilitie
 Chronic stable s
 Inhibits calcium angina.
ion influx across  Vasospatic angina  Monitor
Generic Name: cardiac and (prinzmetal or patient
 Amlodipine smooth-muscle variant angina) carefully
cells, dilates  Hypertension (BP,
coronary cardiac
Dosage: (actual arteries and Contraindication: rhythm
dosage the patient arterioles, and  Amlodipine is and
is taking) decrease blood contraindicated in output).
 10 mg pressure and patients with  Monitor
myocardial known blood
oxygen hypersensitivity to pressure
demand. amlodipine. frequently
Route:
 Amlodipine is .
 P.O (orally)
relatively  Notify
Frequency: contraindicated in physician
Side effect/Adverse patients with if signs of
Reaction: cardiogenic shock, heart
 Once daily
 CNS; severe aortic failure
Classification: headache, stenosis, unstable occur,
somnolence, angina, severe such as
 Calcium fatigue, hypotension, heart swelling
Channel dizziness, light- failure, and hepatic of hands
Blocker headedness, impairment. and feet
 Antianginal paresthesia.  Patients with or
drugs  CV; edema, hepatic impairment shortness
 Antihyperten flushing, may not of breath.
sive palpitations. metabolize
 GI; nausea, amlodipine
abdominal pain. effectively, leading
 GU; sexual to a longer half-life
difficulties. with possible
 Musculoskelet increases in
al; muscle pain plasma
 Respiratory; concentrations.
dyspnea
 Skin; rash,
pruritus
Brand Name: Mechanism of Indication: Nursing
Action: Responsibilities

 Zocor  Indicated for the  Use drug

 Inhibits HMG- treatment of only after diet
Generic Name: CoA reductase, hyperlipidemia to and other
an early (and reduce elevated non-drug
 Simvastatin rate-limiting) total cholesterol therapies
step in (total-C), low- prove
cholesterol density lipoprotein ineffective.
biosynthesis cholesterol  Obtain liver
Dosage: (actual (LDL-C), function test
dosage the patient apolipoprotein B result at start
is taking) (Apo B), and of therapy
Side effect/Adverse triglycerides (TG), and then
 40 mg Reaction: and to increase periodically.
high-density A liver biopsy
 CNS; asthenia, lipoprotein may be
Route: headache cholesterol (HDL- performed if
 GI; abdominal C). enzyme
 P.O pain, elevetionss
constipation,  Indicated to persist.
Frequency:
diarrhea, reduce the risk of
 Once daily dyspepsia, cardiovascular
flatulence, morbidity and
nausea, mortality including
Classification: vomiting. myocardial
 Musculoskelet infarction, stroke,
 HMG-CoA al; myalgia and the need for
reductase  Respiratory; revascularization
inhibitors upper procedures.
respiratory tract
infection.
Contraindication:
 Contraindicated in
patients
hypersensitive to
drug, and those
with active liver
disease or
condition that
cause unexplained
persistent
elevation of
transaminase
level.
 Contraindicated in
pregnant and
breastfeeding
women and in
women of child
bearing age.
Brand Name: Mechanism of Action: Indication: Nursing
Responsibiliti
 Altace,  Through to inhibit ACE,  Hypertension es
Altace preventing conversion  Heart failure
HCT of angiotensin I to after an MI  Monitor
angiotensin II, a potent  To reduce risk blood
vasoconstrictor. Less of MI, stroke pressure
Generic Name: angiotensin II decrease and death from regularly
peripheral arterial CV causes. for drug
 Ramipril resistance, decreasing effective
aldosterone secretions, ness.
which reduces sodium  Closely
Dosage: and water retention and Contraindications: assess
(actual dosage lower blood pressure. renal
the patient is  Contraindicated function
taking) in patients in
Side effect/Adverse hypersensitive patients
 2.5 mg Reaction: to ACE inhibitor during
and in those first few
Route:  CNS; headache, with a history of weeks of
dizziness, fatigue, angioedema therapy.
 P.O asthenia, malaise, light- related to Regular
headedness, anxiety, treatment with assessm
amnesia, depression, an ACE ent of
Frequency:
insomnia, nervousness, inhibitor. renal
 Once neuralgia, neuropathy, function
daily paresthesia, is
somnolence, tremor, advisabl
Classification: vertigo, syncope. e,
 CV; hypotension, heart patients
 ACE failure, MI, postural with
inhibitor hypotension, angina severe
pectoris, chest pain, heart
palpitations and edema. failure
 EENT; epistaxis, whose
tinnitus. renal
 GI; nausea, vomiting, function
abdominal pain, depend
anorexia, constipation, on the
diarrhea, dyspepsia, renin-
dry mouth, angioten
gastroenteritis. sin-
 GU; impotence aldoster
 METABOLIC; one
hyperkalemia, system
hyperglycemia, weight have
gain. experien
 MUSCULOSKELETAL ced
; arthralgia, arthritis, acute
myalgia. renal
 RESPIRATORY; failure
dyspnea, dry, during
persistent, tickling, non- ACE
productive cough. inhibitor
 SKIN; rash, dermatitis, therapy.
pruritus, Hyperte
photosensitivity nsive
reaction, increase patients
diaphoresis. with
 Other; hypersensitivity renal
reaction. artery
stenosis
also may
show
sign of
worsenin
g renal
function
during
first few
first few
days of
therapy.
 Monitor
CBV
with
differenti
al counts
before
therapy
and
periodic
ally
thereafte
r.
 Monitor
potassiu
m level.
Risk
factors
for the
develop
ment of
hyperkal
emia
include
renal
insufficie
ncy,
diabetes
and
concomit
ant use
of drugs
that
raise
potassiu
m level.
 I. STUDY OF ILLNESS CONDITION

ASSESSMENT ORGAN NORMAL MANIFESTATION/ ANALYSIS

INVOLVE FUNCTION PATHOPHYSIOLOGY
Subjective cues; Organs involved Heart pumps Congestive heart failur BNP more
was the heart blood is a complex clinical than
“Napapadalas and other throughout syndrome in which the 100pg/mll
akong hinahapo organs your body, heart cannot pump indicates
kahit konti lang including, lungs, controls your enough blood to meet the
yung ginagawa liver, lower body heart rate the body's possibility of
ko, two weeks ko or abdomen. and requirements. It results heart failure.
na ito maintains from any disorder that High levels
nararamdaman.” blood impairs ventricular filling of creatinine
as verbalized pressure. or ejection of blood to can indicate
Your heart is the systemic circulation. that kidneys
a bit like a Patients usually present aren’t
Objective cues; house. It has with fatigue and working
walls, rooms, dyspnea, reduced well. CBC
Vital signs: doors, exercise tolerance, and test also
BP: plumbing and fluid retention indicated
159/100mmhg an electrical (pulmonary and that patient
T: 36.8 degree system. All peripheral edema). has CHF.
Centigrade PR: the parts of Medical
85 BPM RR: 25 your heart Manifestation of conditions
BPM Weight: 100 work together can cause
Congestive Heart
Kg Height: 180cm to keep blood an increase
flowing and Failure: in red blood
Crackles at the
send cells
base of the lungs
nutrients to  Shortness of include:
Bipedal Edema your other Heart
grade 2+ Muscle organs. breath with activity failure,
Strength of 4/5 on or when lying down causing low
both lower The lungs blood
extremities and  Fatigue and oxygen
Admitting respiratory weakness levels. Low
Diagnosis: Class system allow WBC is
us to breathe.  Swelling in the higher risk
III Heart Failure
They bring legs, ankles and of getting an
oxygen into feet infection.
our bodies When low
DIAGNOSTIC (called  Rapid or irregular white blood
TESTS ● inspiration, or cell count,
heartbeat
Cardiac markers inhalation) immune
BNP: 453pg/mL and send  Reduced ability to system isn't
Troponin (+) carbon working as
exercise
ECG: T-wave dioxide out well as it
inversion. INR (called  Persistent cough should. High
was 1.04 which expiration, or sodium
was lower than exhalation). or wheezing with levels, it
normal while may
white or pink
APTT was found The liver indicate: Dia
is the largest blood-tinged rrhe,
to be slightly
solid organ in mucus disorder of
higher (59.4
the body. It the adrenal
seconds). 2D removes  Swelling of the glands,
Echo – waiting for toxins from belly area kidney
results the body's disorder. Po
(abdomen)
BUN - within blood supply, tassium is
normal limits maintains  Very rapid weight high so it
Creatinine - healthy blood gain from fluid affects the
143µmol/L sugar levels, way heart's
build up
CBC regulates muscles
RBC 4.8/ mcL blood clotting, work. High
 Nausea and lack of
WBC- 9,000/ mcL and performs HbAIC it
hundreds of appetite
Platelet count- may be
other vital a sign of
320,000/ mcL  Difficulty
functions. It is diabetes, a
Sodium- 139 located concentrating or chronic
mEq beneath the decreased condition
Potassium- 3.5 rib cage in alertness that can
mEq the right cause
FBS- 7 mmol/L upper  Chest pain if heart serious
HbAIC- 6.5 % abdomen. failure is caused by health
Lipid profile, Uric a heart attack problems,
acid- within including
normal range heart
Chest Xray – disease,
kidney
Cardiomegaly
disease,
with right and left
and nerve
ventricular damage. As
hypertrophy, fluid the heart
in lower lung weakens, as
fields it can with
heart failure,
it begins to
enlarge,
forcing the
heart to
work harder
to pump
blood on to
the rest of
the body.
An enlarged
heart
(cardiomega
ly) isn't a
disease, but
rather a sign
of another
condition.
All of his
laboratory
test
indicated
that patients
has
congestive
heart failure.