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Jennifer Bell British Heart Foundation Heart Failure Nurse Specialist PowerPoint Presentation
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Jennifer Bell British Heart Foundation Heart Failure Nurse Specialist - PowerPoint PPT Presentation


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Jennifer Bell British Heart Foundation Heart Failure Nurse Specialist. 80 year old male from Langholm Several HF admissions to Cumberland Infirmary Referred by GP Frusemide increased by 40mg. History Severe LVD Hypertension Allergic to ? Penicillin Mural thrombus in LV

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Presentation Transcript
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Jennifer Bell

British Heart Foundation

Heart Failure Nurse Specialist

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80 year old male from Langholm

Several HF admissions to Cumberland Infirmary

Referred by GP

Frusemide increased by 40mg

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History

Severe LVD

Hypertension

Allergic to ? Penicillin

Mural thrombus in LV

Bilateral subdural haematoma 2005

Parkinsons

Prostatism

Medication

Zopiclone 7.5 mg prn

Warfarin Sodium As per INR

Ramipril 10 mg od

Furosemide 40 mg 2pm

Furosemide 80 mg mane

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Symptoms

NYHA Class IV

Paroxysmal Nocturnal Dyspnoea

Severe Orthopnoea/Cheyne Stokes Respirations

Signs

BP (lying) 101/75

BP (standing) 106/71

Pulse 77 bpm

Raised JVP

Weight: 77.6 kg (BMI 23.2)

Widespread creps

Waist oedema

U & E’s, FBC satisfactory

ECG – NRS freq VE’s range 53-109 min

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Plan

Fluid restriction 1500mls

Salt reduction <5g day

Increase frusemide by 40mg

Avoid sleeping tablet and consider Oramorph

? Acute hospital admission ? Palliative referral

Add Spirolactone

Beta blocker contraindicated meantime

District nurses – suitable bed, pressure relieving mattress

Social work dept – benefits, carer input, OT assessment

? Community hospital admission

GP visit requested and further discussion re management

Consider Metolazone

Future D&G cardiology referral/follow-up

actual outcome
Admitted to Community Hospital

Commenced Oramorph &

Spironolactone

Strict fluid restriction

Discharged home 12 days later with community support

3 months later:

NYHA Class III

Progress stable

BP (lying) 123/79

BP (standing) 117/78

Pulse 58 bpm

Weight: 68 kg (BMI 20.3)

Few creps

No oedema

Warfarin Sodium

Ramipril 10mg

Spironolactone 25mg

Bisoprolol Fumarate 1.25mg

Furosemide 40mg 2pm

Furosemide 80mgmane

Oramorph 2.5mg prn

Picolax

Macrogols

Lactulose

Senna

Actual outcome
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COMMENTS / QUESTIONS / SUGGESTIONS FOR FUTURE

? Palliative care referral/joint management

? Dietetic referral

? Cardiology follow up

? Candesartan

? Resynchronisation therapy if criteria met

? Up titrate beta-blocker ? try Nebivolol

? Change nothing meantime