Module 10 Seminar: Nursing Assessments & Heart Failure

Module 10 Seminar: Student copy Learning Outcomes for Seminar Module 10:  Describe common nursing assessments, diagnostics, interventions, rationales, and expected outcomes related to chronic heart failure  Describe common nursing assessments, diagnostics, interventions, rationa...

Module 10 Seminar: Student copy Learning Outcomes for Seminar Module 10:  Describe common nursing assessments, diagnostics, interventions, rationales, and expected outcomes related to chronic heart failure  Describe common nursing assessments, diagnostics, interventions, rationales, and expected outcomes related to peripheral vascular disease Small Group Activity: Complete the following virtual simulation in your small groups. Take notes as needed, look up anything that you are unsure about, and work as a group. We will debrief as a large group afterwards. Simulation: https://app.affinitylearning.ca/community/browse/964 Description: The intent of this virtual simulation is to explore how the interprofessional team works together to support a senior living with heart failure in the community. In this virtual simulation, you will meet Mr. Blair Lowell. He is 82 years of age. He lives in a senior’s apartment building. Throughout, you will have the opportunity to explore video and audio content to learn more about Mr. Lowell. You will also be asked to make informed decisions to assist the team. Your choices and responses will remain confidential, you will not be graded on this simulation. However, you will have opportunities to reflect and there will be a self-debrief at the end to extend your learning. LEARNING OBJECTIVES  Identify early signs and symptoms of an exacerbation in a person living with heart failure.  Complete a comprehensive assessment of a person who presents with an exacerbation of heart failure.  Determine care priorities to support a person in respiratory distress related to heart failure.  Collaborate as a team to support a person living with heart failure in a community setting Resources to help:  Drug reference guide  https://yourcareplus.ca/learn/heart-failure-tool  Lewis textbook and PowerPoint slides Debrief questions: 1. Can someone describe the case from beginning to end? 2. What aspects of the care were you familiar and comfortable with? 3. What aspects of the care did you find new or challenging? 4. What areas do you want to explore further? 5. Does anyone want to describe what they learned through this simulation regarding supporting a senior living with heart failure in a community setting? 6. What are some key take-aways you learned through participating in this simulation? Large group activity: Case Scenario: A 68-year-old patient is admitted to the hospital for shortness of breath. The patient was diagnosed 4 years ago with HF after failing to follow the recommended medical regimen for an MI that occurred 6 years ago. States was taking a diuretic but ran out 4 days ago; has not been able to refill the prescription. States noticing some swelling in the feet that seemed worse than usual. Physical examination:  Alert and oriented to person, place, and time  Fine crackles bilateral lower lobes  Shortness of breath on minimal exertion  O2 saturation 89%, room air  S1 and S2 without murmur or extra heart sounds  Capillary refill sluggish in lower extremities, normal in upper extremities  2+ edema bilateral lower extremities Discussion questions: 1. What is the priority of care for this client? 2. How would the nurse evaluate whether the nursing actions were successful? 3. What teaching measures would the nurse use to prevent a reoccurrence of ADHF? Case Scenario: A 56-year-old client (he/him) arrives at the emergency department after having increased work of breathing and cough for approximately 2 days. Attempts to relieve the symptoms at home were unsuccessful and the severity of his condition has steadily increased. The client’s history reveals a healthy lifestyle, with a history of mitral valve regurgitation, which has been largely asymptomatic. Item: Multiple Choice 1. Through investigations, the client is diagnosed with left-sided heart failure, related to mitral valve regurgitation. Which symptoms would the nurse expect to find on assessment? a) Jugular vein distension (JVD) b) Hepatosplenomegaly c) Peripheral edema d) Pulmonary edema Item: Multiple Response 2. The nurse is providing client and family education related to heart failure, as discharge planning begins. Which of the following is appropriate information to relay to them? (Select all that apply.) a) It is important that the client obtain an annual flu vaccine and pneumococcal vaccine. b) An intensive and rigorous exercise regimen is recommended. c) The client may be at risk for depression, thus it is important to discuss the signs and symptoms. d) Medications may be stopped when symptoms of heart failure are no longer present. e) Either sodium or fluid intake should be restricted, and this should be discussed with the dietitian. f) Timing of medications may help fix some of the adverse effects. g) Encourage the client to join local support networks. Item: Multiple Choice 3. On discharge, the client and the nurse develop a goal of preventing hypervolemia. Which interventions can the client complete independently, in a direct effort to meet this goal? a) Take -blockers as prescribed to decrease preload b) Monitor for desired effects of medications (for, e.g., decreased urine output) c) Check weight daily, and keep a record d) Monitor for adventitious breath sounds Case Scenario: The nurse is providing care to a 57 year-old client (he/him) who has been diagnosed with Critical Limb Ischemia. The client is currently admitted to the acute medical-surgical unit for treatment of a gangrenous ulcer on his left foot. The health care team is discussing treatment options with the client and his partner. Item: Multiple Choice A thorough diagnostic assessment is completed, in order to finalize the plan of care for this client. Which of the following assessment findings should the nurse anticipate in a client with Peripheral Arterial Disease? a) Hypotension b) Intermittent claudication c) Burning pain in thigh at rest d) Increased hair growth in the legs and feet Item: Multiple Choice Management of PAD requires an interdisciplinary, multifaceted approach. Which statement accurately describes a PAD management strategy? a) Smoking and tobacco cessation interventions b) Pharmacological treatment with an oral anticoagulant c) Inclusion of herbal supplements such as homocysteine-lowering vitamins d) Catheter-based intervention are appropriate for all clients with PAD