Heart Failure
M.G. is a 77-year-old woman who saw her health care provider for dyspnea. She is now being admitted to the hospital for acute heart failure (HF). She was diagnosed with HF 6 years ago. She is currently taking the following medications:
Furosemide 40 mg PO daily
Potassium chloride 20 mEq PO daily
Enalapril 10 mg by mouth BID
Subjective Data
Was taking furosemide at home but ran out 2 days ago and has not been able to refill her prescription
Complains of difficulty breathing; had to “sleep in the chair” last night
Has some swelling in her feet that is worse than usual
Objective Data
Physical Examination
Temperature 98.4° F, pulse 92, respirations 24, blood pressure 144/86, oxygen saturation 89% on room air
Height 5’5″, weight 170 lb
Alert and oriented to person, place, and time
Fine crackles bilateral lower lobes
Shortness of breath with minimal exertion
S₁ and S₂without murmur or extra heart sounds
Capillary refill sluggish in lower extremities, normal in upper extremities
2+ pitting edema bilateral lower extremities
Interprofessional Care
Admission orders include:
Oxygen 2 L per nasal cannula
Furosemide 40 mg intravenous BID
Enalapril 10 mg by mouth BID
ECG now
Vital signs with pulse oximetry every 4 hours
2-gram sodium diet
Accurate 24-hour intake and output (I/O)
Daily weight
Question 1
Describe a plan for implementing these orders.
Question 2
Based on M.G.’s clinical manifestations, what type of HF do you suspect?
Question 3
What assessment data will you use to determine the effectiveness of the provider’s orders?
Question 4
What is the rationale for the oxygen, IV furosemide, and enalapril?
Question 5
What are the priority nursing diagnoses for this patient?
Question 6
What other orders might you anticipate for this patient?