A 62-year-old retired elementary school teacher presents to the emergency room with complaints of shortness of breath, swelling, and generally not feeling well.
Related Question #1
What physical assessments are priorities given her symptoms?
Related Question #2
What diagnostic tests should be ordered immediately? Explain the purpose(s) of each.
Part 2
Vital signs are obtained and recorded as BP 90/48, R24, HR 100 irregular and varying pulse quality, T 97.8°F, pulse oximetry at 92%. Cardiac monitor reveals atrial fibrillation with variable ventricular response. The following laboratory values are returned: troponin 0.02 ng/ml, BNP 400, Hb 10.6, Hct 31.8, BUN 44 Cr 2.
Related Question #3
Which of the laboratory tests are abnormal?
Related Question #4
What do the abnormal tests indicate?
Part 3
Physical examination reveals obese white female in acute distress with frequent deep sighing breaths. HEENT unremarkable, CN I to CN XII grossly intact. Responds slowly but accurately and appropriately. Negative jugular vein distention. Chest: crackles lower lobes bilaterally. Pansystolic murmur, irregular rhythm. Abdomen: mildly distended, soft with bowel sounds present all quadrants. No organomegaly. Genitalia: deferred. Extremities: moves all extremities on command. 2+ pitting edema bilaterally.
Related Question #5
Which physical signs and symptoms are indicative of congestive heart failure?
Related Question #6
What are the expected interventions?
Related Question #7
What is the purpose of each of these medications in the treatment of CHF?
Part 4
The patient is admitted with the following diagnoses:
Mitral valve regurgitation
CHF secondary to mitral valve disease
Renal failure secondary to CHF
Atrial fibrillation
Anemia
Related Question #8
Explain the development of congestive heart failure in this patient.
Related Question #9
Explain the relationship between the CHF, renal failure, and anemia.
Related Question #10
What is the significance of the atrial fibrillation?
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