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Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines as well as the course textbook.

Topic: Heart Failure

Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d.

Medical History:

His medical history includes moderate prostatic hypertrophy for 5 years, adult-onset diabetes mellitus for 10 years, hypertension for 10 years, and degenerative joint disease for 5 years.


His medication history includes hydrochlorothiazide (HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d, controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d, and indomethacin (Indocin) 25 to 50 mg three times a day as needed for pain. While reviewing his medical records, you see that his last physical examination revealed a blood pressure of 160/95 mm Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral pulses, mild edema bilaterally in his feet, a prominent S3 and S4, neck vein distention, and an enlarged liver.

Diagnosis: Heart Failure Class II

  1. 1. List specific goals of treatment for Michael.
  2. 2. What drug(s) would you prescribe? Please provide rationales.
  3. 3. What are the parameters for monitoring the success of your selected therapy?
  4. 4. Discuss specific patient education based on the prescribed therapy.
  5. 5. Describe one or two drug–drug or drug–food interactions for the selected agent(s).
  6. 6. List one or two adverse reactions for the selected agent(s) that would cause you to change therapy.
  7. 7. What would be the choice for the second-line therapy?
  8. 8. What over-the-counter or alternative medications would be appropriate for Michael?
  9. 9. What dietary and lifestyle changes should be recommended for Michael?

  • Two scholarly references (text, journal) required for the entire case study.
  • APA formatting is only required for the references.
  • Answers should be in single space paragraph form below each question.

  1. Explain the pathophysiology of Stage A heart failure.
  2. first drug choice drug choice for treatment?
  3. Are there gender considerations related to medication treatment
  4. Discuss monitoring of the pharmacological agent(s) selected.

Please see instructions in attached file. Thanks

Case Study: Heart Failure:

Objective: Identify the type of heart failure based on data presented in the case study. Express your understanding of the pathophysiology and clinical aspects of heart failure. Answer other questions associated with heart failure.


1. Read and review information about the topic. You can use your textbook, ( Porth’s Pathophysiology. Concept of Altered Health States 9th edition. By Sheila Grossman,Carol Mattson Por), other nursing or medical books, scientific articles, or scholarly websites (American Heart Association, Centers for Disease Control and Prevention). All sources used in this assignment must be ‘scholarly sources’. Please remember that WebMD, Wikipedia, and other internet sites are not considered scholarly sources.

2. Carefully, read the case study.

3. Answer the questions that follow the case study. These questions are to be answered in a 3-4-page paper that conforms to APA formatting, including cover page, citations, direct quotes, and reference page.

4. All submitted papers will be analyzed for originality through the Turnitin program. Please refer to the course syllabus for the academic honesty statement which includes plagiarism.

5. Please review and understand the grading rubric for each assignment.

Case Study: Heart Failure:

Carol is a 68-year-old African-American female who went to her doctor’s office because of a “racing heart”. She has been experiencing a worsening of shortness of breath over the last 2 months. Over the last 3 weeks, she noticed swelling of her ankles and feet. Carol states that she feels weak and tired most of the time. She has been awakened in the middle of the night with severe shortness of breath despite sleeping on 3 pillows.

Carol’s past medical history includes: a myocardial infarction several years ago, high cholesterol, gastroesophageal reflux, and osteoarthritis. She has allergies to nuts, shellfish, and strawberries.

Carol has a family history of atherosclerosis, myocardial infarction, and stroke.

Carol has been a 2-pack-per-day cigarette smoker for 30 years. She has been trying to quit smoking since her heart attack. Carol states she occasionally drinks alcohol.

Physical Examination:

Blood pressure: 163/94

Heart rate: 125 beats per minute and regular

Respiratory rate: 28 breaths per minute and labored

Temperature: 98.6 F

Height: 5’8”

Weight: 215 lbs.

Skin: is pale with cool hands and feet.

Positive jugular vein distention

Lungs: bibasilar rales (crackles) on auscultation

Abdomen: hepatomegaly (enlarged liver)

Extremities: bilateral pitting edema of lower extremities


B-type Natriuretic Peptide (BNP) – 885 pg/mL (normal=100 pg/mL)


1. Explain the pathophysiology of left-sided heart failure and right-sided heart failure.

2. In a chart, please compare and contrast the signs and symptoms of left-sided and right-sided heart failure.

3. Based on the information given in this case study, what type of heart failure do you

suspect that Carol has developed?

a. Identify specific data from the case study that supports your answer.

b. Explain the pathophysiology for the data you identified in 3a. Be sure to cite your references.

4. What is the probable cause of the heart failure?

5. Identify 4 risk factors that probably contributed to Carol’s past heart attack. Please

indicate if each risk factor is modifiable or not.

a. How does Carol’s blood pressure affect her current health status?

b. Why is Carol tachycardic?

c. Why is Carol tachypneic?

d. Based on her BMI, what can you say about Carol’s weight?

Grading criteria:

Points Content
5 Cover page with project title, student name, institutional affiliation, Running head, and page number
20 Explain the pathophysiology of left and right-sided heart failure
15 Compare signs and symptoms of left and right-sided heart failure
15 Which type of heart failure is Carol experiencing and rational/support decision (Question 3)
20 Identification of specific data to support decision on type of heart failure (Questions 3a,3b)
5 Explain the cause of Carol’s heart failure
5 Identify 4 risk factors Carol has for heart failure
5 Writing and grammar: sentence structure, logical flow, no spelling errors, and grammar usage
10 Paper in APA format including page numbers, proper margins, proper font, citing references in the text, and complete reference list.

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