“An 84-year-old woman with known heart failure presented with dyspnea
for 4 week
“An 84-year-old woman with known heart failure presented with dyspnea for 4 weeks
during which time she developed dyspnea and fatigue on minimal exertion and even at rest.
She also complained of orthopnea and reported that most of the past week she slept sitting
in a recliner. Prior to sleeping on a recliner, she had had one episode of paroxysmal
nocturnal dyspnea. Her past medical history was remarkable for hypertension. She denied
chest pain, palpitation or dizziness. She also reported right upper quadrant pain associated
with nausea and loss of appetite but no vomiting. She had chronic leg swelling which has
gotten so severe over the past several weeks that she could not wear her shoes. She
responded to her worsening symptoms by restricting her activities and did not see her
physician. At the emergency department, her jugular venous pressure was elevated at 15
cm of water. She had positive hepatojugular reflux, a right-sided third heart sound and an
enlarged soft tender liver. She had no pulmonary râles or wheezing. She had severe bilateral
pitting edema in both of her legs up to mid-thigh areas with multiple blisters over lower
legs. She also had evidence of venous insufficiency with brown pigmentation and induration
of skin. A loud second heart sound at left fourth intercostal space suggested that her
estimated pulmonary artery systolic pressure was elevated at 40–45 mm Hg. She had
normal sinus rhythm by an electrocardiogram. Her chest radiograph was remarkable for
marked cardiomegaly and pulmonary venous congestion. Her prior left ventricular ejection
fraction was unknown and a subsequent echocardiogram revealed a left ventricular ejection
fraction of >55%” (Ahmed, A., 2009, para 4).Outline a treatment plan which is detailed
(specfic medication that need to be used and specfic treatment) and focused based upon
your diagnoses for this patient, using the evidence based guidelines provided in this week’s
reading. Explain your clinical decision making and why each treatment would be essential
to the treatment of this patient.THIS IS CARDIACSET IT UP IN SOAP FORM WITH BULLETS