Jim (Left Sided HF) case study for nursing

Jim, case study on left sided heart failure

1. Jim (Left Sided HF)

2. Evaluation Looking at Jim’s presentation, I would put a tentative diagnosis of heart failure, but I would most definitely do more digging around to see what type of heart failure it would be, left-sided, right-sided sided or both. Knowing his presentation with dyspnea on exertion that worsens vs, feeling fine at rest, and his apical impulse is displaced laterally. Plus knowing his PMH of hypertension and alcohol use), would lead me to suspect Left-sided heart failure.

3. Confirm Diagnosis To confirm the diagnosis, I would get an : ECG chest x-ray BNP CBC A1C BMP Lipid levels

4. Treatment/Drugs I would start Jim with at least some anti-hypertensive drug(s), to start until the diagnosis of suspected Left Heart Failure could be finalized. I would start Jim on Carvedilol 3.125mg twice a day for about 2 weeks, and also spironolactone 20mg per day for 2 weeks. I would also consider some ACE inhibitors as well like lisinopril. I would titrate gradually for the carvedilol, pending on how his BP looks/labs/ and imaging shows.

5. Evaluation/Follow Up I would educate Jim on the importance of monitoring his vital signs, especially his BP (there could be a chance that hydralazine might need to be added if the BP does not come down therapeutically), and I would also talk to Jim about him avoiding alcohol. In the way of follow-up, I would advise regular follow-up’s/imaging and lab work to make sure that everything is working appropriately for him.

6. References: McGraw Hill (Assess Medicine). (n.d.). Heart Failure with Reduced Ejection Fraction ( HFrEF ). https://accessmedicine-mhmedical- com.mutex.gmu.edu/CaseContent.aspx?gbosID=463879&gb osContainerID =224&viewByNumber=false&groupid=1344#2 11128856