Well, as wonderful as my life is for the most part these days, there always has to be SOMETHING that's not quite right, and here it is: My 58-year-old sister has just been diagnosed with heart failure.
What we don't know is why this has crept up on her all of a sudden. One day she was feeling her usual self and going about her appointed rounds, and the next day she woke up horribly short of breath, more tired than when she went to bed, and with more edema than usual in both ankles. In addition, her blood pressure was sky-high (200/110 as opposed to her usual 150/80 range), and she was weak and dizzy. So she went to the doctor and they drew a BNP, which was somewhere in the 540 range, but her cardiac enzymes and EKG were normal. They also did an echocardiogram which showed slight enlargement of the heart, but nothing to account for the dramatic symptoms she's been experiencing.
They put her on Lasix, 40 mg. BID, which had the appropriate effect of diuresing her and improving her breathing within 24 hours, and now she's on Cozaar and atenolol as well as potassium replacement therapy. Her labs look much better this week---her electrolytes are back within normal limits, anyway---and her lungs are much better, but she continues to feel tired all the time, and becomes exhausted with even minor exertion. She is a legal secretary and recently had to go to four-hour workdays because of all this, but even the minimal physical effort required is too much for her. So I'm very concerned, to say the least.
Now, as a med/surg nurse I've seen CHF in almost every type of patient imaginable, but I'm having a hard time understanding why my normally hale and hearty sister has come down with it. She hasn't smoked in almost 10 years, she's had some mild HTN for a few years but it's always been controlled with medication, she is almost NEVER sick, she eats well, and while she's overweight, she can hardly be considered morbidly obese. Her main issue is stress---her employer is a nasty, demanding, cheap, slave-driving sonuvabee who treats her like a piece of machinery, and sometimes is even verbally abusive to her. The family and I have all tried to get her to look elsewhere, but she's gotten so beaten down by this @$$**** that whatever confidence she had in herself has pretty much evaporated, especially after being rejected for a new job with the city government. I've half-joked for years that this job was going to be the death of her, and now I'm afraid I might end up being right after all---dead right.
On top of all this, I can't get her to deal with the 'indigestion' she keeps having---even her MD said that the second she starts feeling discomfort ANYWHERE in the chest or epigastric region, she is to take some NTG and call 911---but she doesn't want to 'endanger her insurance' by taking more time off work. I understand that, but what good will insurance do her if she's not here to use it? Of course, that's what really bothers me.......she's the last surviving member of my family of origin, and I'm just not ready to lose her. She hasn't had an MI, at least not yet, but the doctor thinks one may be in the offing, particularly if the stress level and the BP don't come down soon. And neither looks like it's going to happen; her systolic's staying in the 170-180 range even with the meds, and the more she stresses over work (specifically NOT being there), the worse she feels.
If any of you have any ideas/suggestions for her (or me!), would you please share them? It's one thing to take care of CHF patients in one's practice; it's quite another when the patient is your best friend and only living relative!
Thank you, and once again, Merry Christmas to everyone here at allnurses :icon_bigg
