chf case studty(draft)

8/11/2019 Chf Case Studty(Draft)

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Introduction:

For the purpose of privacy and confidentiality, the real name of the patient in this Case Study is withheld and she will refe rred to as

Patient X

Patient X is a 98 years old female who was currently residing at San Miguel, Tarlac City. Patient X was admitted at the Central Luzon

Doctors Hospital last July 6, 2014 at 10:40pm with a chief complaint of difficulty of breathing.

Background Knowledge

Congestive Heart Failure describes the inability or failure of the heart to adequately meet the needs of organs and tissues for oxygen and

nutrients. This decrease in cardiac output, the amount of blood that the heart pumps, is not adequate to circulate the blood returning to the heart

from the body and lungs, causing fluid (mainly water) to leak from capillary blood vessels. This leads to the symptoms that may includeshortness

of breath,weakness,and swelling.

What Causes Congestive Heart Failure?

There may be many potential reasons for a patient to develop heart failure. It may be due to structural damage to the heart, inability of the

heart to squeeze properly, medications or drugs that affect heart function, lung disease, and other underlying medical diseases. More than one

cause may be present at the same time.
http://www.medicinenet.com/shortness_of_breath/symptoms.htmhttp://www.medicinenet.com/shortness_of_breath/symptoms.htmhttp://www.medicinenet.com/weakness/symptoms.htmhttp://www.medicinenet.com/weakness/symptoms.htmhttp://www.medicinenet.com/shortness_of_breath/symptoms.htmhttp://www.medicinenet.com/shortness_of_breath/symptoms.htm


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Risk Factors

Congestive heart failure is often a consequence of atherosclerotic heart disease and therefore the risk factors are the same: poorly

controlled high blood pressure, high cholesterol, diabetes,smoking,and family history.Heart valve diseasebecomes a risk factor as the patient

ages. (ww.medicinenet.com)

Congestive Heart Failure Symptoms

The hallmark symptom of left heart failure is shortness of breath or dyspnea (dys=abnormal + pnea= breathing). This may occur while at

rest, with activity or exertion, while lying flat (orthopnea), or may awaken a patient fromsleep (paroxysmal nocturnal dyspnea). The shortness of

breath may be due to fluid (water, mainly) accumulation in the lungs or the inability of the heart to be efficient enough to pump blood to the

organs of the body when called upon in times of exertion orstress.Chest pain or angina may be associated, especially if the underlying cause of

the failure is atherosclerotic heart disease. (www.medicinenet.com)
http://www.medicinenet.com/smoking_and_quitting_smoking/article.htmhttp://www.medicinenet.com/heart_valve_disease/article.htmhttp://www.medicinenet.com/sleep/article.htmhttp://www.medicinenet.com/stress/article.htmhttp://www.medicinenet.com/chest_pain/article.htmhttp://www.medicinenet.com/chest_pain/article.htmhttp://www.medicinenet.com/stress/article.htmhttp://www.medicinenet.com/sleep/article.htmhttp://www.medicinenet.com/heart_valve_disease/article.htmhttp://www.medicinenet.com/smoking_and_quitting_smoking/article.htm


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When to Call the Doctor

The Doctor should be called if there are signs and symptoms of congestive heart failure and any of these situations:

Symptoms ofsudden heart failure,such as:o Severe shortness of breath (trouble getting a breath even when resting).o Suddenly getting an irregular heartbeat that lasts for a while, or getting a very fast heartbeat along

withdizziness,nausea,orfainting.

o Foamy, pink mucus with a cough and shortness of breath.o Chest pain or pressure, or a strange feeling in the chest.o Sweating.o Shortness of breath.o Nausea or vomiting.o Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.o Lightheadedness or sudden weakness.o A fast orirregular heartbeat.
http://www.webmd.com/hw-popup/sudden-heart-failurehttp://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overviewhttp://www.webmd.com/digestive-disorders/digestive-diseases-nausea-vomitinghttp://www.webmd.com/brain/understanding-fainting-basicshttp://www.webmd.com/pain-management/guide/whats-causing-my-chest-painhttp://www.webmd.com/skin-problems-and-treatments/hyperhidrosis2http://www.webmd.com/heart-disease/guide/what-causes-heart-palpitationshttp://www.webmd.com/heart-disease/guide/what-causes-heart-palpitationshttp://www.webmd.com/skin-problems-and-treatments/hyperhidrosis2http://www.webmd.com/pain-management/guide/whats-causing-my-chest-painhttp://www.webmd.com/brain/understanding-fainting-basicshttp://www.webmd.com/digestive-disorders/digestive-diseases-nausea-vomitinghttp://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overviewhttp://www.webmd.com/hw-popup/sudden-heart-failure


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Nursing Process

A. Nursing health history

A. Demographic Data

Name: Patient X

Address: San Miguel, Tarlac City

Gender: FemaleAge: 98 yrs. Old

Birthdate: August 9, 1915Religion: Catholic

Date of admission: july 6, 2014 / 10:40pm

Attending Doctor: Conrado R. Genilo III MDAdmitting Doctor: Maricis C. Lopez MD

B. Chief complaint

Patient X was brought to the hospital and seek medical attention due to the chief complaint of difficulty of breathing

C. History of present illness

1 day prior to admission the patient manifest difficulty of breathing and easy fatigability with edema at both low extremities.


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Review of System

General Appearance

Weight loss Weight gain Anorexia Fatigue

Weakness Night sweats Generalized jaundice

Note: the patient has weak in appearance

Skin

Itch Bruising Rash Bleeding

Lesions Blister Ecchymoses Burns Drainage

Note: No abnormalities in skin found

Ears

Pain Discharge Tinnitus


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Hearing loss

Note: the patient has slightly hearing loss due to aging

Nose

Obstruction Epistaxis Discharges

Note: no abnormalities in skin found

Throat & Mouth

Sore throat Bleeding gums Tooth Ache

Tooth Decay

Note: No abnormalities in throat and mouth

Chest


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Cough Hemoptysis Wheeze Pain in Respiration

Dyspnea Sputum Rales

Note: the patient is unable to expel sputum, suctioning performed. Dyspnea and rales is the symptoms of CHF.

CVS

Chest pain Palpitation Dyspnea Edema

Orthopnea Others__________

Note: Chest pain, Palpitation and Edema because of congestion

GIT

Intolerance Heartburn Nausea Jaundice

Vomiting Pain Bleeding Excessive Gas


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Constipation Change in BM Melena

Note: no abnormalities in GIT found

Genito Urinary

Dysuria Nocturia Retension Polyuria

Dribbling Hematuria Flank Pain Tea colored urine Oliguria

Note: patient experience Oliguria and tea colored urine due to concentration.

Neuro

Headaches Dizziness Memory Loss Fainting Numbness Tingling

Seizures

Paresis Paralysis

Others: ________________

Notes: patient has memory loss due to aging.


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Anatomy and Physiology

To understand what occurs in heart failure, it is useful to be familiar with the anatomy of the heart and how it works. Theheart is composed of two independent pumping systems, one on the right side, and the other on the left. Each has two

chambers, an atrium and a ventricle. The ventricles are the major pumps in the heart.

The external structures of the heart include the ventricles, atria, arteries, and veins. Arteries carry blood away from the heart while

veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and

high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low

content of carbon dioxide.

The Right Side of the Heart


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The right system receives blood from the veins of the whole body. This is "used" blood, which is poor in oxygen and rich incarbon dioxide.

The right atrium is the first chamber that receives blood. The chamber expands as its muscles relax to fill with blood that has returned from the body. The blood enters a second muscular chamber called the right ventricle. The right ventricle is one of the heart's two major pumps. Its function is to pump the blood into the lungs. The lungs restore oxygen to the blood and exchange it with carbon dioxide, which is exhaled.

The Left Side of the Heart

The left system receives blood from the lungs. This blood is now oxygen rich.

The oxygen-rich blood returns through veins coming from the lungs (pulmonary veins) to the heart. It is received from the lungs in the left atrium, the first chamber on the left side. Here, it moves to the left ventricle, a powerful muscular chamber that pumps the blood back out to the body. The left ventricle is the strongest of the heart's pumps. Its thicker muscles need to perform contractions powerful enough to

force the blood to all parts of the body. This strong contraction produces systolic blood pressure (the first and higher number in blood pressure measurement). The

lower number (diastolic blood pressure) is measured when the left ventricle relaxes to refill with blood between beats. Blood leaves the heart through the ascending aorta, the major artery that feeds blood to the entire body.

The Valves

Valves are muscular flaps that open and close so blood will flow in the right direction. There are four valves in the heart:

The tricuspid regulates blood flow between the right atrium and the right ventricle. The pulmonary valve opens to allow blood to flow from the right ventricle to the lungs. The mitral valve regulates blood flow between the left atrium and the left ventricle. The aortic valve allows blood to flow from the left ventricle to the ascending aorta.


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Pathophysiology

Left Sided Congestive Heart Failure

Pathophysiology

Causes

o Myocardial Infarctiono Hypertensiono Aortic stenos is insufficiencyo Mitral stenos is insufficiency

Reduced myocardial contractility

Increases cardiac workload

Decreased diastolic filling

Left atrial pressureLeft sided CHFBloods dams back intothe pulmonary

capillary bedStroke volume decreases

Pressure at the

pulmonary capillary bedTissue perfusion

decreases

Cellular h oxiaPulmonar edema

Bloods flow to the kidneys

RAAS stimulation

Vasoconstriction and

reabsorption of Na and water

ECF volume

S/S

Total blood volume

Systemic BP


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DRUG STUDY

Drug Name Classification Dosage Action Contraindication Adverse Effect Nursing Responsibilities

Clopidogre

1 bisulfate

Anti platelet

Drug

75mg

1 tab

OD

Inhibits platelet

aggregation by

inhibiting binding

of adenosipine

diphosphate to its

platelet receptor

and subsequent

ADP- mediative

activation ofglycoprotein

complex

Lactation Active

pathological

bleeding such as

peptic ulcer or

intracranial

hemorrhage.

GI bleeding, purpura,

bruising,

hematoma,

epistaxis,

hematuria,

eye bleeding

(mainly conjunctiva),

intracranial bleeding,

GI disturbances,

diarrhea, rash,

pruritus

-Assess for any active bleeding

as with ulcers or intracranial

bleeding

-take exactly as directed, may

take without regard to food.

Food will lessen chance of

stomach upset

-report any unusual bruising or

bleeding; advise all providers

of prescribed therapy


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Lasix Loop diuretic 1 amp

IVP

q8

Inhibits sodium and

chloride

reabsorption at the

proximal tubules,

distal tubules and

ascending tubules

loop of henle

leading to excretion

of water together

with sodium,

chloride and

potassium diuretic,

antihypertensive.

Hypersensitivity

to sulfonylureas

anuria

Orthostatic

hypotension,

thrombophlebitis,

chronic aortitis,

vertigo,headache,

dizziness, paresthesia,

restlessness, fever

photosensitivity,

urticarial, pruritis

necrotizing angitis

-monitor the blood pressure,

fluid intake and output,

electrolytes: potassium,

sodium, calcium, magnesium,

glucose, uric acid and BUN

-monitor neurologic

manifestation of hypokalemia,

hypomagnesemia,

hyponatremia, hyperchloremia

-monitor intake and output

-assess patient for tinnitus,

hearing loss, ear pain


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Ranitidine Histamine H2

Receptor

blocking drug

50mg

IV

q12

Competitively

inhibits gastric acid

secretion by

blocking the effect

of histamine H2

receptors both

daytime and

nocturnal basal

gastric acid

secretion, as well as

food and

pentagastrin

-simulated gastric

acid are inhibited

Hypersensitivity

History of acute

Porphyria

Long term therapy

Cardiac arrhythmias,

bradycardia, headache,

fatigue, dizziness,

hallucination,

depression, insomnia

-use caution in presence of

renal hepatic impairment

-assess potential for

interactions with other

pharmacological agents patient

may be taking

- assess knowledge/ teach

patient appropriate use,possible side effects/

appropriate interventions, and

adverse symptoms to repot


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Rosuvastatin

calcium

Anti-

hyperlipidemic

20 mg 1

tab OD

A fungal metabolite

that inhibits the

enzyme (HGM-

CoA) that catalyzes

the first step in the

cholesterol

synthesis pathway,

resulting in a

decrease

In serum

cholesterol, serum

LDLs (associated

with increased risk

of coronary artery

disease) and either

an increase or no

change in serum

HDLs (associated

with decreased)

hypersensitivity,

impaired hepatic

function,

alcoholism, renal

impairment,

advanced age,

hypothyroidism

Nausea, dyspepsia,

diarrhea, constipation,

vomiting, rhinitis,

sinusitis, cough,

dyspnea, pneumonia

-Arrange for proper

consultation about need for

diet and exercise changes

-Administer drug at bed time

-Monitor patient closely for

signs of muscle injury,

especially higher doses

-Provide comfort measures to

deal with headache, muscle

cramps, or nausea

-Offer support and

encouragement to deal with

disease, diet, drug therapy, and

follow-up care.


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Kalium

durule

electrolytic

and water

balance agent

1 tab

TIDPrincipal

intracellular cation;

essential for

maintenance of

intracellular

isotonicity,

transmission of

nerve impulses,

contraction ofcardiac, skeletal,

and smooth

muscles,

maintenance of

normal kidney

function, and for

enzyme activity.

Plays a prominent

role in both

formation and

correction of

imbalances in acid

base metabolism.

Severe renal

impairment; severe

hemolytic

reactions; untreated

Addisons disease;

crush syndrome;

early postoperative

oliguria (except

during GIdrainage);

adynamic ileus;

acute dehydration;

heat cramps,

hyperkalemia,

patients receiving

potassium-sparing

diuretics, digitalis

intoxication with

AV conduction

disturbance.

Nausea, vomiting,

diarrhea, abdominal

distension.

Pain, mental confusion,

irritability, listlessness,

paresthesias of

extremities, muscle

weaknessand heaviness

of limbs, difficulty inswallowing, flaccid

paralysis.

Oliguria, anuria.

Hyperkalemia

-Monitor I&O ratio and pattern

in patients receiving the

parenteral drug. If oliguria

occurs, stop infusion promptly

and notify physician.

-Monitor for and report signs

of GI ulceration (esophageal or

epigastric pain or

hematemesis).

-Monitor patients receiving

parenteral potassium closely

with cardiac monitor. Irregular

heartbeat is usually the earliest

clinical indication of

hyperkalemia.

-Be alert for potassium

intoxication (hyperkalemia, see

S&S, Appendix F); may result

from any therapeutic dosage,

and the patient may be

asymptomatic.


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18/33


Cordarone Anti-

arrhythmics

200mg

1 tab

TID

Effects result from

blockade of

potassium

chloride leading to

a prolongation

potential duration.

-Contraindicated

In patients

hypersensitivity

to drug or iodine.

-Those with

cardiogenic shock,

second or third

degree AV block,

severe SA node

disease resulting

in bradycardia

unless an artificialpacemaker is

present, and in

those for whom

bradycardia has

caused syncope.

CNS : fatigue, malaise,

tremor, peripheral

neuropathy, ataxia,

paresthesia, insomnia,

sleep disturnbances,

headache.

CV: hypotension,

bradycardia,

arrhythmias, heart

failure, heart block,

sinus arrest, edema.

EENT: visual

disturbances, optic

neuropathy, or

neuritis resulting in

visual impairment,

abnormal smell.

GI : Nausea, vomiting,

abnormal taste,

anorexia,constipation,

abdominal pain.

Hematologic :

coagulation

abnormalities

Hepatic : hepatic

-Monitor blood pressure and

heart rate and rhythm

frequently.

-Perform continuous ECG

monitoring when starting or

changing doses. Notify

prescriber or significant

change in assessment result.

-Watch carefully for

pulmonary toxicity.

-Watch for evidence ofpneumonitis, exertional

dyspnea, non productive

cough, and pleuritic chest

pain.


19/33

failure , hepatic

dysfunction

Metabolic :

hypothyroidism,

hyperthyroidism.

Respiratory : acute

respiratory isease

distress syndrome,

SEVERE PULMONARY

TOXICITY.

SKIN :

photosensitivity, solar

dermatitis, blue gray

skin.


20/33


Lactulose Contraindicated

in patients on a

low galactose

diet.

1tbsp

HSProduces an

osmotic effect in

colon ; resultingdistention

promotes

peristalsis. Also

decrease

ammonia,

probably as a

result of bacterial

degradation,

which lowers the

pH of colon

contents.

Contraindicated in

patients on a low

galactose diet.

Abdominal cramps,

belching, diarrhea,

flatulence, gaseous

distension. Nausea,

vomiting.

-To minimize sweet taste,

dilute with water or fruit

juice or give with food.

-Prepare enema by adding

200g (300ml) to 700 ml of

water or normal saline

solution.

-Monitor mental status

-Replace fluid intake.

-Inform patient aboutadverse reactions and tell

him to notify prescriber if

reactions become

bothersome or if diarrhea

occurs.


21/33

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective:

Objective:Patient

manifested:

Generalized

weakness

(+) DOB

Easy fatigability After nursing

intervention the

patient will able to

show strength and

energy

1. Assess vital

signs.

2. Determine

presence ordegree of

sleep

disturbances.

3. Obtain clientdescriptions

of fatigue.

4. Ask client torate fatigue.

5. Planinterventions

to allowindividually

adequate rest

periods.

6.Assist with

self-care

needs and

ambulation.

7. Avoidexposure to

temperature

and humidity

extremes

8. Instruct clientin ways to

monitor

responses to

1. To evaluate

fluid status

and

cardiopulmonary

response to

activity.

2. Fatigue canbe a

consequence

of sleep

deprivation.

3. To assist inevaluating

impact onclients life.

4. To

determine

degree of

fatigability.

5. To maximizeparticipation.

6. To conserve

energy for

other tasks.

7. Has negativeimpact on

energy level.

8. Indicate the

need to alter

activity level

9. To promote

For further

management


22/33

activity and

significant

signs or

symptoms.

9. Promote

overall healthmeasures

10.Providesupplemental

oxygen, as

indicated.

11.Assist clientto identify

appropriate

coping

behaviors.

energy

10.Presence ofhypoxemia

reduces

oxygen

available forcellular

uptakes and

contributes

to fatigue.

11.Promote

sense of

control and

improves

self-esteem.

Assessment Diagnosis Planning Intervention Rationale Evaluation


23/33

Subjective:

Objective:Patient

manifested:

productive

cough

yellowish in

color

presence of

rales upon

auscultation

(+) DOB

Impaired Gas

exchange

After nursing

intervention the

will able to breath

w/o oxygen

therapy, and

decrease secretion

production.

1. Monitor and

record vital

signs

2. Observe colorof skin,

mucous

membranes

and nail beds,

noting

presence of

peripheral

cyanosis.

3. Elevate head

of bed and

encourage

frequent

position

changes.

4. Keep back dry.

5. Promoteadequate restperiods

6. Changeposition q 2

hrs.

7. Keepenvironment

allergen free

8. Suction

secretions

PRN9. Administer

oxygen

therapy as

ordered.

1. To obtain

baseline data

2. Cyanosis of

nail beds

may

represent

vasoconstric

tion or the

bodys

response to

fever/ chills

3. To promotemaximal

inspiration,

enhance

expectoratio

n of

secretions in

order to

improveventilation

4. To avoid

coughing

5. Rest will

prevent

fatigue and

decrease

oxygen

demands for

metabolic

demands6. To promote

drainage of

secretions

7. To reduce

irritant

effects on

airways

8. To clear

For further

evaluation and

management


24/33

airway when

secretions

are blocking

the airway.

9. O2 therapy is

indicated toincrease

oxygen

saturation


25/33


Subjective:(none)

Objective:Patient

manifested:

Edema on

extremities

( 6mm)

DOB

Excess Fluid

Volume

-After nursing

intervention the

patient will be

able to decrease

difficulty of

breathing.

-patients edema

will decrease from

(6mm) to 0.

-

1. Establish rapport

2. Monitor and recordVS

3. Assess patientsgeneral condition

4. Monitor I&O every 4hours

5. Assess for presenceof peripheral edema.

Do not elevate legs if

the client is dyspnic.

6. Follow low-sodium

diet and/or fluid

restriction

7. Encourage orprovide oral care q2

8. Monitor for

distended neck veins

and ascites

9. Evaluate urineoutput in response

to diuretic therapy.

10.Assess the need foran indwelling

urinary catheter.

11.Institute/instructpatient regarding

fluid restrictions as

appropriate.

1. To gain

patients trust

and

cooperation2. To obtain

baseline data

3. To determine

what

approach to

use in

treatment

4. I&O balance

reflects fluid

status

5. Decreasedsystemic

blood

pressure to

stimulation of

aldosterone,

which causes

increased

renal tubular

absorption of

sodium Low-

sodium diet

helps prevent

increased

sodium

retention,

which

decreases

water

retention.

For further

management and

evaluation


26/33

Fluid

restriction

may be used

to decrease

fluid intake,

hencedecreasing

fluid volume

excess.

6. The clientsenses thirst

because the

body senses

dehydration.

Oral care can

alleviate the

sensationwithout an

increase in

fluid intake.

7. Heart failure

causes venous

congestion,

resulting in

increased

capillary

pressure.

When

hydrostatis

pressure

exceeds

interstitial

pressure,

fluids leak out

of ht

ecpaillaries


27/33

and present

as edema in

the legs, and

sacrum.

Elevation of

legs increasesvenous return

to the heart.

8. Inidicates

fluid overload

9. Focus is on

monitoring

the response

to the

diuretics,

rather than

the actualamount

voided

10.Treatmentfocuses on

diuresis of

excess fluid.

11.This helpsreduce

extracellular

volume.


28/33


Subjective:(none)

Objective:Patient

manifested:

Edema on

extremities

(grade 6)

DOB

Excess Fluid

Volume

-After nursing

intervention the

patient will be

able to decreasedifficulty of

breathing.

-patients edema

will decrease from

( grade 6) to 0.

-

12.Establish rapport13.Monitor and record

VS

14.Assess patients

general condition

15.Monitor I&O every 4

hours

16.Assess for presence

of peripheral edema.

Do not elevate legs if

the client is dyspnic.

17.Follow low-sodiumdiet and/or fluid

restriction

18.Encourage orprovide oral care q219.Monitor for

distended neck veins

and ascites

20.Evaluate urine

output in response

to diuretic therapy.

21.Assess the need for

an indwelling

urinary catheter.

22.Institute/instructpatient regarding

fluid restrictions as

appropriate.

12.To gainpatients trust

and

cooperation

13.To obtainbaseline data

14.To determinewhat

approach to

use in

treatment

15.I&O balancereflects fluid

status

16.Decreasedsystemicblood

pressure to

stimulation of

aldosterone,

which causes

increased

renal tubular

absorption of

sodium Low-

sodium diethelps prevent

increased

sodium

retention,

which

decreases

water

retention.

For further

management and

evaluation


29/33

Fluid

restriction

may be used

to decrease

fluid intake,

hencedecreasing

fluid volume

excess.

17.The clientsenses thirst

because the

body senses

dehydration.

Oral care can

alleviate the

sensationwithout an

increase in

fluid intake.

18.Heart failure

causes venous

congestion,

resulting in

increased

capillary

pressure.

When

hydrostatis

pressure

exceeds

interstitial

pressure,

fluids leak out

of ht

ecpaillaries


30/33

and present

as edema in

the legs, and

sacrum.

Elevation of

legs increasesvenous return

to the heart.

19.Inidicates

fluid overload

20.Focus is on

monitoring

the response

to the

diuretics,

rather than

the actualamount

voided

21.Treatmentfocuses on

diuresis of

excess fluid.

22.This helpsreduce

extracellular

volume.


31/33


Subjective:

PainObjective:Patient

manifested:

(+) DOB

with a rate of

6 out of 10

with

complaints of

chest painunprovoked

Acute Pain The patient will

verbalize decrease

of pain.

1. Assess

patient pain

for intensity

using a painrating scale,

for location

and for

precipitating

factors.

2. Provide

comfort

measures.

3. Establish aquiet

environment.

4. Elevate head

of bed.

5. Monitor vital

signs,

especially

pulse and

blood

pressure,

every 5

minutes until

pain

subsides.

6. Teachpatient

relaxation

techniques

and how to

use them to

1. To identify

intensity,

precipitating

factors andlocation to

assist in

accurate

diagnosis.

2. To providenonpharmacolo

gical pain

management.

3. A quietenvironment

reduces theenergy demands

on the patient.

4. Elevationimproves chest

expansion and

oxygenation.

5. Tachycardia and

elevated blood

pressure usually

occur with

angina and

reflect

compensatory

mechanisms

secondary to

sympathetic

nervous system

stimulation.

6. Anginal pain is

For further

management and

evaluation.


32/33

reduce

stress.

often

precipitated by

emotional stress

that can be

relieved non-

pharmacologicalmeasures such

as relaxation.


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chf case studty(draft)

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