MS II: Cardiovascular disorder case study: HF
Scenario: An 82-year-old woman with a history of chronic heart failure is in the Emergency
Department with increased dyspnea, extreme fatigue, and a non-productive cough. She states that
she can hardly walk to the bathroom from her bedroom without having to stop to rest. Her lower
legs are swollen with 3+ edema, and she states that she has gained about 8 pounds over the past
few days. When questioned about her medications, she states, “I have been skipping my fluid pill
because I hate having to go to the bathroom so much. I get so short of breath.”
Vital signs: Temperature 99.9°F (37.7°C), Pulse 110/bpm and regular, Respirations 28/min,
Blood Pressure 188/98 mm Hg.
She is admitted to the telemetry unit with a diagnosis of exacerbation of heart failure, and given
prophylactic anticoagulant therapy, aggressive diuretic therapy, as well as an ACE inhibitor. After
a week, the nurse documents the following assessment findings.
NGN Item Type: Matrix
For each assessment finding, use an X to indicate whether the interventions were Effective
(helped to meet expected outcomes), Ineffective (did not help to meet expected outcomes),
or Unrelated (not related to the expected outcomes).
Assessment Finding Effective Ineffective Unrelated
Edema in the lower legs is measured at
Patient can walk to the bathroom and
back without becoming fatigued and
short of breath.
Patient states that she will take her
diuretic every morning by 9 AM.
Body temperature maintained at 99°F
(37.2°C) or below.
Weight has increased by 2.2 kg in 2
Patient can balance physical activity
with periods of rest to avoid over-
The patient reports no chest pain with
The patient’s morning blood pressure is
Rationale: Explain your reasons for your decisions
1. What diagnostic test/procedure should be included in this patient’s care?