Charles, A Case Study on CHF
Triaging Patients with Chronic Illnesses
Intro : While nurses do not diagnose conditions per say, we do develop “working diagnoses” which help to determine the proper level of care for our patients. There are several key strengths a good triage nurse has; a diverse nursing background, listening skills, and asking the right questions.
Nurses that tend to excel at telephone triage are the ones that have experience with many different types of patients – they understand the anatomy and physiology of the human body along with a basic understanding of medications. Today patients often present with many co-morbidities, causing them to be more susceptible to dangerous complications even a relatively minor illness.
The more pertinent information the nurse can collect, the more likely she is to understand what is causing the patients symptoms and how to assist the patient in getting to the most appropriate level of care. When presented with a complicated patient, the nurse must review the past medical history, medication use, current symptoms and how these symptoms are affecting the patients ADL’s – in other words, is this something that needs to be seen in an Emergency Room or can it wait until the patient’s physician can see them?
Charles is a 60-year-old male who was discharged from hospital 3 days ago for an acute flare up of his chronic condition. It is 8:30pm and he is calling nurse triage with increased Dyspnea and Orthopnea. He says he hasn’t done anything different since being discharged but is still feeling very tired all day – “more than usual”. He says his shortness of breath is worse when lying flat, so he slept in his recliner last night. Charles says he has some swelling around both ankles that is new today. He also tells the nurse that he has gained 5 pounds since yesterday morning. Charles is A&O x 3.
PMH : The nurse is able to ascertain that Charles had been smoking 1 pack of cigarettes a day for 20 years but quit almost 5 years ago. He rarely drinks alcohol and does not use street drugs. Charles is a supervisor at a warehouse which he tells the nurse involves some walking but most of his day is sitting behind a desk or at a work site. He lives with his wife of 40 years and has 3 grown children, all of whom are very involved and supportive to their parents. In addition to the chronic condition he is calling for tonight, Charles has a history of HTN, Hyperlipidemia and had an MI 5 years ago.
Medications : Daily medications for Charles include Lasix (diuretic), Vasotec (ACE Inhibitor), and Toprol (Beta-blocker).
Management : Charles tells the nurse he has been talking with a Disease Case Manager for the last 2 years to help him manage his condition. She recommended a salt restricted diet, restricting his fluid intake, checking his weight every day and mentioned talking to his doctor about starting a walking regime each day.
Conclusion : What condition is Charles most likely diagnosed with? CHF is a condition where the heart cannot pump enough blood to the body’s other organs. The most common symptoms are LL edema or dyspnea at rest or with little exertion and fatigue. CHF is diagnosed based on past medical history, physical examination and specific laboratory tests. While there is no cure for CHF, lifestyle modifications such as reducing salt and exercising, taking medications as directed by a physician and managing stress can improve many patient’s quality of life.