Case Study
Review all of the data in the following case study and answer the 5 questions below with 3 APA resources to support your work:
A 60-year-old client presents to the ED with severe onset shortness of breath, fatigue, and recent weight gain of 5kg. The client reports difficulty sleeping. He states, “I feel like I am drowning.” He reports using multiple pillows to improve this feeling without relief. This is the client’s second hospital admission this year for a similar complaint. His past medical history is significant for heart failure, a 20-year pack history of smoking, COPD, coronary artery disease, myocardial infarction, hypertension, hyperlipidemia, diabetes mellitus, and obesity. Past surgical history is significant for cardiac catheterization with stent placement. The client’s family reports he is not adherent to his medication regimen. He likes to eat fast foods and frozen dinners for most of his meals a week. He does not engage in exercise and lives a sedentary lifestyle.
Medication list includes:
1. Lasix 20 mg by mouth twice daily
2. Metformin 500 mg by mouth twice daily
3. Nebivolol 5 mg by mouth daily
4. Aspirin 81 mg by mouth daily
5. Rosuvastatin 40 mg by mouth daily
6. Lisinopril 20 mg by mouth daily
7. Fluticasone-vilanterol 100-25 mg inhaled daily
8. Albuterol-ipratropium inhaled every 4 hours as needed
9. Digoxin 60 mg PO daily
Physical Exam:
Initial physical exam reveals temperature 98.4F, heart rate 128/min, respiratory rate 28, BP 180/95, Height 160 cm, Weight 100 kg, BMI 39.1, oxygen saturation 90% on room air.
Alert and oriented x3, anxious, PERRLA, Cranial nerves 1-12 intact, Cardiac assessment reveals S1, S2, and S3 heart sounds, bilaterally pitting edema +2. Auscultation of the lungs revealed bibasilar pulmonary rales. There use of accessory muscles, nasal flaring, and severe shortness of breath. The abdomen is distended and non-tender, there is positive hepatojugular reflux, JVD >4cm. All other assessment findings were normal.
Diagnostics
EKG and chest x-ray revealed cardiomegaly, vascular engorgement, and mild interstitial edema.
Labs: Na 128 mEq/L, K 5.2 mEq/L, BUN 82 g/dL, Crt 1.8 mg/dL, trop I 0.1 ng/mL , BNP 1300 pg/mL, Glu 140 g/dL.
Answer the following 5 questions. Use APA at least 3 references to support your work, you can use the course text as one of your references. The references should be scholarly resources.
1. What are priority NANDA nursing diagnosis and interventions with rationales from evidence based literature for this client? (List at 3 diagnosis with 2 interventions per diagnosis).
Nursing Diagnosis
a. Intervention with rationale
b. Intervention with rationale
Nursing Diagnosis
a. Intervention with rationale
b. Intervention with rationale
2. List at least 4 signs and symptoms of heart failure:
a. Right sided heart failure
b. Left sided heart failure
3. From the case study identify heart failure symptoms in this client including history, diagnostics, and physical exam findings.
4. Provide the rationale for each of the following therapies for heart failure clients. Use APA references to support your work.
Oxygen administration:
Diuretics:
Inotropic drug therapy:
Vasodilator drug therapy:
Fluid restriction:
Sodium restriction:
5. What should a nurse include when planning discharge teaching for a client with heart failure? How can the nurse prevent rehospitalization in this client?
h a population of 1.3 Billion people and 800-900 Million who are eligible to vote, India calls itself the largest democracy in the world (“National Interest”). India runs a federal form of government and proclaims that they can transfer power peacefully every five years since 1951, except for Ghandi’s experiment of autocracy in 1975 (“National Interest”). The political environment is greatly influenced by factors such as government’s policies, politician’s interests, and the ideologies of several political parties (“PESTLE-ANALYSIS”) The democratic will of the people is reflected in the local and national elections and is mostly accepted and also respected by the people and their politicians. The political culture of tolerance is a very dominant factor when it comes to maintaining a stable political climate. This is very important in order to attract FDI. However, sporadic political unrest is not very uncommon. For example at the moment India is preparing for its mammoth general elections, which are held every five years. One political unrest which has been around for the past year is the increasing violence against minorities since the pro hindu sentiment five years ago. (“lowyinstitute”)
One major area of political concern in India is corruption. Currently India is ranked 78/180 with a score of 41 on the corruption index (“Transparency”) Although India does not show the best results it shows a steady increase and less corruption every year. The Indian government created initiatives to combat the challenges of corruption. In 2018 Parliament passed the Prevention of Corruption (Amendment) Act introducing changes to the existing anti-corruption law (“Lexology”). India does this to be more democratic and also to be more interesting for other countries. Often companies do not consider FDI is because of corruption rankings in the desired country.
According to the Economic Complexity Index (ECI), India is the 17th largest export economy in the world and the 45th most complex economy. In 2017, India exported $292B and imported $417B, resulting in a negative trade balance of $125B. In 2017 the GDP of India was $2.6T and its GDP per capita was $7.06k (“OEC”). In 2012 India exported $ 273 B. This means that India has increase at an annualized rate of 1.2% from 2012 to 2017. (“OEC”) When it comes to imports India imported $ 449 Bn 2012. India therefore has an annualized rate of -1.6 % from 2012 to 2017. (“OEC”)