PMH: HTN, hyperlipidemia, MI 3 years ago

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PLEASE RESPOND TO THE FOLLOWING CLASSMATE’S POST IN 50 WORDS OR MORE:

Option 2

S.P. is a 75-year-old woman who presents to the provider’s office with fatigue.

Subjective Data

PMH: HTN, hyperlipidemia, MI 3 years ago

Fatigue started about a month ago, getting worse

Relieved with rest, exacerbated with activity

Denies chest pain

Ankles swollen

Objective Data

Vital signs: T 37 P 112 R 18 BP 110/54

Lungs: bilateral lower lobe crackles

O2 Sat = 94%

Skin = cool to touch

CV = heart rate regular, positive peripheral pulses, ECG = no changes

+2 edema bilateral ankles

Medications: Metoprolol 20 mg per day, 325 mg of aspirin per day

Questions

What other questions should the nurse ask about her fatigue?
Is your fatigue associated with any shortness of breath (SOB)?
How has it affected your activities of daily living (ADL’S)?
How has your fatigue affected your appetite?
How has your fatigue affected your sleep?
2) What other assessments are necessary for this patient?

Additional questions that the nurse should ask S.P. include,
Have you experienced any orthopnea? (SOB while lying flat and relieved when sitting up)

Have you experienced any palpitations with or without lightheadedness?

Chest x-ray- to assess for pulmonary edema/vascular congestion
Labs- Troponin, CBC, CMP, BNP, Liver function test, blood urea nitrogen.
Echocardiogram- to determine ventricular function and hemodynamics.
3) What are some causes of fatigue?

Congestive Heart failure (CHF)
Hypoglycemia
Respiratory virus
Lack of sleep
Poor oral intake of required nutrients
4) Develop a problem list from the objective and subjective data.

S.P. is presenting with symptoms that are consistent with CHF. Symptoms of heart failure include those related to excess fluid accumulation and reduced cardiac function.

S.P. presents with +2 edema bilateral ankles, fatigue relieved with rest and exacerbated with activity, bilateral lower lobe crackles, and increased heart rate (HR 112).

Other symptoms of HF may include dyspnea, orthopnea, pain from hepatic congestion, abdominal distention from ascites.

5) What should be included in the plan of care?

Getting orders to diuretics if applicable
Relieving signs and symptoms of fluid overload
Teaching patient about dietary restrictions

Sample Solution

Great response to the case of S.P.! Here are some additional thoughts:

Questions:

  • Social history: Ask about alcohol and tobacco use, caffeine intake, and social support systems.
  • Psychological history: Explore for stress, anxiety, or depression, which can contribute to fatigue.
  • Medications: Inquire about over-the-counter medications or supplements that could interact with current prescriptions.
  • Travel history: Consider recent travel for potential infections.

Assessments:

  • Jugular venous distention (JVD): Check for jugular vein distention while the patient is at a 45-degree angle.
  • Weight: Monitor weight changes to track fluid status.
  • Abdominal exam: Assess for ascites, hepatomegaly, or splenomegaly.

Causes of fatigue:

  • Anemia: Include iron studies in your lab recommendations.
  • Thyroid dysfunction: Consider thyroid function tests.
  • Chronic infections: Rule out infections like HIV or hepatitis.
  • Medications: Some medications can cause fatigue as a side effect.

Problem list:

  • Fatigue (new onset, progressive)
  • Edema (bilateral ankle)
  • Bilateral lower lobe crackles
  • Tachycardia

Plan of care:

  • In addition to your suggestions, consider oxygen therapy if hypoxic.
  • Patient education on signs and symptoms of worsening CHF and medication adherence.
  • Follow-up appointments to monitor response to treatment.

Overall, your response demonstrates a strong understanding of heart failure and the patient’s presentation. The additional questions and assessments you suggest are valuable for further evaluation.

 

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