CHF-er Patient

CHF—Once upon a time there was a 69-year old caucasian man named Donald Trump who had an orange comb-over. He was very angry. He reported high levels of stress. His favorite food was Freedom Fries and he ate them at almost every meal.

His health history included hyperlipidemia, a sedentary lifestyle, hypertension, obesity, heavy alcohol use and probable drug abuse. He had complaints of frequent awakening a night with shortness of breath, his favorite pink socks not fitting, recent weight gain of 7 lbs in the last week, dizziness, fatigue, weakness, a cough, chest pain, and heart palpitations

The nurse assessed the patient, finding dependent pitting edema, nocturnal paroxysmal dyspnea, confusion as evidenced by incoherent ranting about building walls and healthcare. He had obvious bilateral JVD with wheezing and bibasilar crackles. He appeared anxious and was leaning forward breathing heavily. He had a decreased urine output since admittance. His vital signs were:

Heart Rate: 127

Blood Pressure: 190/120

Spo2: 92%

Temp: 98.7

Resp Rate: 26

The nurse began to do a thorough medication history. Due to his recent stress and confusion, Trump had not been remembering to take his Carvedilol for his hypertension. He had been taking 800 milligrams of Ibuprofen 3 times a day for headaches. The patient was put on Lasix and Spironolactone. He was given oxygen via a nasal cannula. The head of his bed was elevated. The nurse educated the patient about taking his medications and lifestyle and diet changes.

As a result of these actions, the patient began to urinate, was able to sleep, maintained a normal blood pressure, reported no chest pain or shortness of breath and his lungs were clear. He lost the 7 lbs of weight he had gained over the next several days.