history of Congestive Cardiac Failure | My Assignment Tutor

Mr Clive Jenkins Consider the Patient Situation Mr Clive Jenkins is a 78-year-old retired navy engineer. He has a past medical history of Congestive Cardiac Failure (CCF). This developed after he experienced a severe myocardial infarction 2 years ago. Both ventricles were affected. The recent death of several close friends have made it difficult for Clive to be concordant with his CCF management and sustain the necessary life-style adjustments required to prevent exacerbations. This has resulted in several admissions to hospital for management and review of his CCF. For this current admission, Mr Jenkins was referred to hospital by his GP after recently rapidly gaining weight (currently 95kg), since his last visit the previous week. The time now is 0800 and you have just come on for your morning shift. Mr Jenkins has been on the ward for only two hours after spending approximately 12 hours in emergency waiting for a bed to become available. Mr Jenkins appears slightly disoriented. When repositioning himself in bed you observe that he becomes short of breath. You ask him if he will get out of bed for breakfast, but he is reluctant to mobilise as he feels so tired. You also note that his water jug is empty. Collect cues. You review the following documentation: (see the attachment.) CLIVE JENKINS GP Letter.pdf CLIVE JENKINS IV fluid orders.pdf CLIVE JENKINS Medication Chart.pdf CLIVE JENKINS Observations Chart.pdf CLIVE JENKINS Progress notes.pdf Upon undertaking a further assessment of Mr Jenkins you obtain the following new information: Vital SignsRR: 24Sp02: 94% on 2lt via nasal prongsBP: 150/90HR: 112bpmTemp: 36.5oC Other informationBGL within normal rangeGCS 14 – Eye opening – 4; Verbal response – 4; Best motor response – 6 Hydration status assessmentPeripheral pulses difficult to palpatePresence of pitting oedema bilaterallyCapillary refill – 5 secondsCurrent weight 97kg.Raised JVPOutput since midnight: 200ml; Input since midnight: approx 1672 mL (oral and IV) Abdominal assessmentAbdomen soft and non-tender.Bowel sounds present. Respiratory assessmentBibasilar posterior cracklesIncreased work of breathingPatient producing pink-tinged frothy sputum Clive’s myocardial infarction caused the death of areas of his cardiac tissue. Which of the following is earlier in the cascade of events leading to cell death? Question 1 Clive myocardial infarction caused the death of areas of his cardiac tissue. Which of the following is easier in the cascade of events leading to cell death? ischaemianecrosishypoxiaapoptosis Question 2 (1 point) Clive’s myocardial infarction caused the death of areas of his cardiac tissue, causing irreversible cell death. Which of the following was NOT experience by these cells? Question 2 options: apoptosishypoxianecrosisischaemia Question 3 (1 point) Clive suffered a myocardial infarction two years ago. Which of the following could have been the cause of it? Question 3 options: a ruptured atherosclerotic plaque in his coronary arteryan embolus formed in his left femoral veininflammation due to myocardial cell deatha thrombus travelling from the right ventricle Question 4 (3 points) Which of the following are possible manifestations (signs or symptoms) of an acute myocardial infarction? Select all that apply, leave blank those that do not apply. Marks lost by incorrect choices (right minus wrong) Question 4 options: crushing chest pain relieved at resthot, flushed skinsudden leg weaknessparaesthesia in arms or legsbradycardiacold and pale skindiaphoresissudden drop in blood pressuresudden dizzinesschest pain that is not relieved by glyceril trinitratefatiguesudden elevation in blood pressuretachypnoeadyspnoea Question 5 (3 points) Clive has congestive heart failure. Which of the following are manifestations of this cardiac condition? Select all that apply. Marks lost for incorrect answers (right minus wrong). Question 5 options: Chest pain on exertionBradycardiaOliguriaPeripheral oedemaDry coughDifficulty concentratingTachycardiaNocturiaWeight lossDyspnoeaFatigueElevated JVPPulmonary oedemaOrthopnea Question 6 (2 points) According to the “HFrEF Management algorithm” by The National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand (CSANZ) guidelines for heart failure, in which order should the therapeutic approaches to Congestive Heart Failure be introduced? Question 6 options: Mineralocorticoid Receptor AntagonistLifestyle modifications: exercise and reduction of salt intake.Diuretics ACE inhibitors or ARBsBeta-Blocker Question 7 (1 point) Clive’s peripheral oxygen saturation is 94% with oxygen supplementation. Which of the following is altering his oxygen homeostasis so that he needs the oxygen therapy? Question 7 options: excessive ventilation of the alveoli due to tachypnoeaincreased work of breathing causes ineffective alveolar ventilationoedema is interfering with the gas exchangepulmonary blood circulation is too fast due to the tachycardia Question 8 (3 points) Clive’s RR increased from 15-19 at 0600 to 24 breaths per minute in your last observation, but his oxygen saturation remained constant. What could be the reason for this?  Select all possible answers, leave the incorrect answers unselected. Marks lost for incorrect answers. (Right minus wrong). Question 8 options: his brain is receiving less oxygenated blood and is compensating by increasing RR.he is hypercapnic or becoming hypercapnic, which stimulates the increase in RR.his pulmonary circulation is less effective, causing the increase in RR.his pulmonary oedema has worsened.his SpO2 levels have dropped, not reflected in the oxygen saturation.the gas exchange is less efficient, and the increase in blood CO2.his anxiety due to disorientation is activating the sympathetic nervous system.the respiratory centres activate the sympathetic nervous system, increasing the RR. Question 9 (4 points) Clive was prescribed with ramipril 5mg for the management of his congestive heart failure. Which of the following can be achieved by taking this drug? Select all that apply, leave blank all that do not apply. Marks lost for incorrect answers. (Right minus wrong). Question 9 options: Decreased sodium reabsorption in the kidneys.Reduction of pulmonary oedemaDecreased cardiac output.Reduction of Sympathetic Nervous System activity.Blockage of angiotensin receptors.Reduced formation of Angiotensin I.Peripheral vasodilation.Inhibition of aldosterone release.Decreased Mean Arterial Blood Pressure.Increased diuresis.Coronary artery vasodilation.OliguriaReduced formation of Angiotensin II.Reduced heart rate. Question 10 (4 points) Clive was prescribed with Spironolactone 25mg for the management of his congestive heart failure. Which of the following can be achieved by taking this drug? Select all that apply, leave blank all that do not apply. Marks lost for incorrect answers. (Right minus wrong). Question 10 options: Inhibition of aldosterone action.Increased diuresis.Decreased sodium reabsorption in the kidneys.Peripheral vasodilation.Reduced heart rate.Coronary Artery vasolidation.Reduction of pulmonary oedemaReduction of Sympathetic Nervous System activity.Decreased cardiac output.Reduced blood return to the heart.Reduced formation of Angiotensin II.Increased strength of cardiac muscle contraction.Decreased Mean Arterial Blood Pressure.Oliguria Question 11  Clive’s HR of 112bpm is contrary to what would be expected to a compensation for a blood pressure of 150/90 mmHg. Explain what the normal response should be, and the pathophysiological mechanisms for Clive’s tachycardia. Word limit: 200 words excluding in-text references. Use the School of Nursing guidelines for UTas Harvard referencing. (need references) Question 12  Relating to Clive’s past and present medical history, explain the rationale why Mr Jenkins was prescribed Ramipril.Word limit: 200 words excluding in-text references. Use the School of Nursing guidelines for UTas Harvard referencing. (need references)

QUALITY: 100% ORIGINAL PAPER – NO PLAGIARISM – CUSTOM PAPER

Leave a Reply

Your email address will not be published. Required fields are marked *