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Discussion

Left-sided heart failure

He is 80 years old, 64 kg and 182cm. His condition has progressed to the worse, and fluid can be observed in the lungs by using stethoscope. He is blue on lips, ears and fingers. His bloodpressure is meassured to 140/90, while his pulse frequency is 110/min. He has problems with breath, and is put on air. The patient gets treated with meds ( Enalspril, Furosemid and Amoxcillin), and his condition improves greatly within the next few hours.

The next day he feels sick, and gets diagnosed with pnemoni. He cought up green slime, and get put on antibiotics.

Could someone give me some hints on how to threat this patient in this situation? Any help is great! :)

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    I don't really understand - you said he was put on Amoxil on the first day, this is an antibiotic. Then you said he was started on antibiotics the second day...??

    In any case, I'm not sure what you are asking. How to treat? He is being treated correctly with O2, ACE inhibitor, diuretic for his heart failure.

    Cyanosis is a late sign of severe heart failure - he may need inotropic drugs like milrinone or dobutamine to give him enough circulation to perfuse his peripheries.

    140/90 is a very high BP for someone with such severe HF. Usually you want the afterload (diastolic BP) MUCH lower than this so the left ventricle does not have such a high pressure to push against. He may need his ACE inhibitor increased significantly, or he may need a beta blocker added.

    In terms of nursing management, cluster activities so that he can rest in between, manage I&O's carefully, restrict fluids, low sodium diet, chest physiotherapy/incentive spirometry, deep breathing and coughing exercises.

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    My bad, he was only on Renitec before.

    Thanks alot for answer!

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    Btw, could pnemoni be misdiagnosed with fluid in the lungs?

    Sorry about my English.

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    Must be a great steth to be able to "observe" fluid in the lungs.

    I'm just sayin'.

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    I don't know that making fun of someone's English is necessary.

    Possibly someone could be misdiagnosed with pneumonia when they have CHF-related fluid in the lungs.. but pneumonia is usually diagnosed by other things than just listening to the lungs - like a fever, green sputum, other signs of systemic infection, chest xray etc.

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