Case Study #4: Heart Failure (HF)
Place: Medical Ward
“Hi Jill, how are you doing? Is this Mrs. Smith?” asks Simone.
“Hi Simone, yes this is Mrs. Smith. Did someone pass on my phone report to you?”
“Yeah, I got the message. Do you have the transfer note and orders?”
“Here is the transfer note summarizing the care thus far and here is Dr. Smythe’s transfer note and his orders,” Jill says as she hands over the information. “He knows you will change them to support Mrs. Smith better.”
Simone carefully reads through Jill’s transfer note. “So she has had all her diagnostics but no cardiac meds?”
“That is correct.”
“Ok, I’ll get the team to see her as soon as we have her settled.”
Simone, Jill, and Glen maneuver the stretcher into a semi-private room and help Meryl transfer to the bed near the window. Jill takes the cartridge out of the portable monitor and slips it into the monitor above the bed. Watching carefully, she sees the monitor boot-up and display Meryl’s vital signs.
|Day: 0||Pulse Rate||Blood Pressure||Respiratory Rate||Temperature||O2 Saturation|
|Time: 17h30||110||90/60||22||36.5°C||95% with 4 LPM|
“Is this more comfortable than the stretcher?” Jill asks Meryl.
“Most definitely. Thank you.”
“Glen, can you hook up the nasal prongs to oxygen at 4 LPM please? Great, thank you.” Jill then turns to Dorothy and Meryl, “Mrs. Smith, it was a pleasure to meet you and I hope everything turns out well for you.”
In unison both Dorothy and Meryl thank Jill for her assistance.
Glen and Jill reverse the stretcher and head out the door. Jill checks in with Simone before she leaves. “Simone, do you need any more information or are you good?”
“Family aware?” asks Simone.
“Yes, Dorothy is the wife and she has been updating siblings. I have had no contact with any other family. Dorothy was stressed on admission, but seems to have settled right now. They seem to be good people with what appears to be bad luck.”
“Ok Jill, thanks. If anything crops up before the end of the shift, I’ll call you.”
Both Glen and Jill wave and head to the elevators to get back to the Emergency Room.
Simone approaches the nursing station and sees the Cardiology team sitting at the small conference table in the middle of the nursing station.
“Hi Dr. Grant, Meryl Smith has just arrived from Emergency. She is the newly diagnosed heart failure patient.”
“Yes, I was talking with Dr. Smythe about her. Have they started any cardiac meds?”
“No. They have left that to you and the team to start. Essentially she has had all her diagnostics done, but no interventions. She is stable right now. On 4 LPM nasal prongs. Sinus rhythm. I haven’t done an assessment yet and wonder if we should all go in and talk with her and her wife.”
“I think that’s a great idea. We will be there in a couple of minutes. Simone, please go in and let her know she will have the team come and see her shortly.”
“Excellent. Will do.”
Simone heads to Meryl’s room to let her know the plan.
“Hi Mrs. Smith, my name is Simone and I’m one of the cardiology nurses that will be caring for you while on the unit. In a few minutes, the cardiology team will be in to assess you and ask you a few questions. We are going to do our assessments together and this way we coordinate our care and plan the best approach for you, and you get to ask any questions you have. Does this sound ok?”
“It’s a bit overwhelming.”
“I understand that. It is a lot to take in. Remember we are here to help you get better.”
“I realize that. It’s just so new.”
Dr. Grant then enters the room with the cardiology team.
“Good afternoon Mrs. Smith! My name is Dr. Neal Grant and these people behind me compose the cardiology team.”
“I’m Dennis, a senior resident.”
“I am Haley, the cardiology pharmacist.”
“I’m Harjinder, the junior resident.”
“I am Addy, the dietician for cardiology.”
“Ok, now that is a lot of names right now. We would like to get to know you a bit better, have a listen to your heart and lungs, and then plan out the interventions that will make you feel better than you do right now. How does that sound?”
Both Meryl and Dorothy nod but look a bit shy with six people standing around the bedside.
Dorothy asks, “Do you need me here?”
Dr. Grant nods. “I would like you to stay here so you can get the same information and it helps us learn about your wife. You are integral to her care especially when we send her home which I hope is a couple of days from now.”
Dorothy smiles at that but stands up and moves away from the bedside to give the cardiology team more room.
Dr Grant begins by asking general health questions, about activity levels, and then steps forward to listen to Meryl’s chest. Haley asks about medications at home, both prescribed and over-the-counter. Addy inquires about diet and activity. The two residents follow Dr. Grant’s lead and perform a physical assessment.
After 30 minutes of questions and assessment, Dr. Grant steps to the end of the bed “Ok, I think that is all for now. What I would like to do is start you on some medications. A beta blocker to slow your heart beat a bit so that the heart can fill better, an ace-inhibitor to decrease your blood pressure and then a drug to make you urinate a bit more to get rid of the extra fluid you are carrying around. These are common medications for patients that have your type of disease. They are also powerful medications and can cause you to be dizzy or not feel like yourself which is why we are going to keep you here to monitor you and make sure you are stable on the meds before going home. You will know they are working when you do not need oxygen any more. Do you have any questions?”
“No, but it’s a bit much to take in right now. Dorothy?”
Dorothy nods. “I agree with Meryl. Let’s just sit with what you have told us and maybe we’ll have questions later.”
“That sounds good. I am on call all this week so you will see me each morning during rounds. Please ask any questions then or ask Simone here or another member of the team. We are all here to make sure you get better”
Dr. Grant then turns and leaves the room followed by the team and Simone.
In the nursing station, Dr. Grant facilitates a debrief of everyone, which leads to each making their own notes in Meryl’s chart and Dennis writing the orders for the medications that Dr. Grant talked about.