Case Study: Nursing Care for CHF Exacerbation in an Elderly Patient

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Introduction:
The case study is about an old man name Mr. Smith who is 70 years of age and has
been experiencing his CHFexacerbation. He has been suffering from pleuritic pain, dimness,
exhaustion, a hacking cough along with bilateral bibasal coarse crackles. He has been on few
medications such asFurosemide20 mg Mane, Atorvastatin 20m Mane,Metformin XR 1000mg
BD. He has a medical history ofMI, hypercholesterolemia, hypertension, anginaand increased
BMI 34andT2DM. After he was hospitalized the vital signs that were observed are Temp at
36.8, HR 105,GCS 15, Sp02- 92%, NiBP- 170/90, RR 24. The ECG report of Mr. Smith
showed some new abnormalities and the blood report showed anundesirable troponin of TNI:
0.02. studying the case study, the ABCDE frame work of nursing was used to understand and
assess the issue and provide proper treatment for the condition that was evaluated. Proper
interventions required in the nursing care for the respective issues are also discussed and a
proper discharge planning is also outlined for the better outcome of Mr. Smith.
Primary priorities
ABCDE frame work is a nursing frame work which is found to help in evaluating and
providing treatment for disease. The ABCDE stands for Airway, Breathing, Circulation,
Disability, Exposure, is amethodology used in order to treat critical patient in case of
emergency. Mr. Smith is an old man of 70 years of age and has been experiencingcongestive
heart failureexacerbation. He was also witnessing pleuritic chest pain, breathing problem,
exhaustion, weakness and for few days he has also been suffering from hacking cough which
is linked with bilateral bibasal coarse crackles.
Airway- Mr. Smith has been experiencing an acute chest pain related with witnessing
shortness of breath. He was witnessing serious hacking cough that was associated with the
bilateral bibasal coarse crackles, which was found reflecting obstruction in the respiratory

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passage of Mr. Smith. The adequate amount of oxygen was supplied into the body by oxygen
mask to Mr. Smith to relive him from pain and medication furosemide was administered for
the CHF issue (Ohad et al. 2018).
Breathing- Mr. Smith was witnessing serious problem of shortness of breath. The respiratory
rate of Mr. Smith was 24beats/minutes where is normal 12-20 beats/minutes. Sp02 of Mr.
Smith was 92% but normal sp02 level should be 94%-100% and between 88%to 94% in case
of patient suffering from chest pain and respiratory complications. Oxygen therapy was
continuously provided to Mr. Smith to treat the issue of shortness of breath.
Circulation- Mr. Smith has been suffering from various kind of disorder such as,
hypercholesteremia, where the quantity of cholesterol increases in a person’s blood. He has a
medical history of hypertension, a condition where the blood pressure increases; NiBP of Mr.
Smith was 170/90, the normal range should be 120/80. The blood flow of Mr. Smith was
decreased which a reason behind the occurrence of myocardial infection causing chest pain
was also known as Angina. Negative troponin was examined in the blood (0.02). Morphine
and paracetamol was provided to Mr. Smith to reduce his pain and Atorvastatin for
hypercholesteremia (Li 2015).
Disability- After calculating the blood glucose level it was observed that Mr. Smith was
suffering from type 2 Diabetes Mellitus. BMI of Mr. Smith was 34, greater than the normal
level (18.5- 24.9), which indicated his obesity condition. Mr. Smith was facing fatigue and
weakness and he was administered with Metformin is provided for diabetes (Forslund et al.
2015).
Exposure- Mr. Smith was worried and anxious about the fact that which one is responsible
for acute MI. His heart rate, sp02, respiratory rate BGl, NiBP was monitored continuously.

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Interventions
The issues that were observed in case of Mr. smith are; impaired gas exchange and excess
amount of fluid deposit in lungs which was causing the hacking cough.
For impaired gas exchange
Intervention 1:Providing oxygen supplement via oxygen mask.
It is important to administrate supplemental oxygen to patients in critical clinical
conditions. Oxygen therapy is a methodology used in clinical process for supplying
adequateamount of oxygen to person in need. Oxygen therapy is also used to removethe
loculated air from the chest. The initial supply for oxygen therapy is decided clinically
focusing on theevaluation of the patient, lab reports and the knowledge about the disease and
the patient’s critical condition (Hsu et al. 2018). In case of Mr. Smith who is suffering from
impaired gas exchange condition, he needs proper amount of oxygen supply in his body. The
nurse should provide him with non-re-breathing oxygen mask to provide him with the
appropriate amount of oxygen into his body to avoid circumstances due to shortage of
oxygen.
Rationale: the early supply of oxygen therapy is an important aspect of nursing intervention
for patients with in impaired gas exchange as early mortality can take place if the patient
faces oxygen shortage which will effect thetransfer of oxygenated blood into the brain and
other vital organs of the body (Koshy, Pellicori and Clark 2016).
Intervention 2: Supporting patient with deep breathing and coughing techniques
(positioning, encouragement spirometry, regular position changing, bandagingthe chest).
It is essential to maintain the position in which the patient is lying in the bed.
Elevating the position of the patient’s head in a semi-fowler’s positionis one of the techniques
that supports patient with deep breathing and coughing in case of impaired gas exchange. It is
also important to changeMr. Smith’sposition after every 2 hours and the nurse should keep a