CHF Scenario
Patient Information and History
Name: Charles Jones
Gender: Male
Vital Signs: 98.6, 170/88, 96, 24,
DOB: 07/04/1948
92% RA, and pain score 5.
Weight: 82 kg (180 pounds)
Height: 72 inches (6 feet)
Race: Caucasian
Religion: Catholic
Major Support: Wife
Allergies: No Known Allergies
Social History:
Mr. Jones lives with his wife and they both retired 3 years ago. He worked
as a school maintenance supervisor. Mr. Jones has 3 adult children who
are very supportive of their parents.
Prior Medical History:
Mr. Jones has had hypertension for the last 10 years, and was diagnosed
with atrial fibrillation and congestive heart failure 5 years ago. He has
hyperlipidemia. He has been smoking 1 pack of cigarettes per day for 20
years, but quit smoking 2 years ago. He is a social drinker only.
Immunizations are current with his annual flu vaccine.
Recent Medical History:
Mr. Jones presented to the Emergency Department with dyspnea,
orthopnea, fatigue, a weight gain of 10 pounds, and ankle edema. He also
reports chest pain on the left side, nonradiating, sharp, 5 on a scale of 0 to
10. His appetite is poor, he complains of slight nausea, no emesis. His last
lung assessment revealed breath sounds including fine crackles in the
bases bilaterally, no cough, and 3+ edema in the lower extremities.
Time 8:45 a.m.
An echocardiogram performed upon admission showed ejection fraction
(EF) of 35%. The chest x-ray revealed bilateral congestion to the lower
lungs. Mr. Jones was admitted to a telemetry unit.
Charles Jones – Lab and Diagnostic Tests
Yesterday- Complete Blood Count
Patient
Hemoglobin (g/dl)
Hematocrit (%)
RBC's ( x 106 /ml)
Platelet count
15.4
38.4
4.8
238,000
Male Reference
Female Reference
Range
Range
14.0 – 18.0
12.0-16.0
37.0-49.0
36.0-46.0
4.5-5.5
4.0-4.9
100,000 – 450,000
Comprehensive Metabolic Panel (CMP)
Glucose
Calcium
Albumin
Prealbumin
Total Protein
Sodium
Potassium
CO2
Chloride
BUN
Creatinine
ALP (Alkaline
Phosphatase)
AST (Aspartate amino
transferase—SGOT)
ALT (alanine amino
transferase—SGPT)
Bilirubin, Total
Total Cholesterol
Patient
Reference Range
87
9.4
3.7
19
7.0
140
3.0 L
25
100
18
0.9
70
60-99
8.8-10.3
3.5-5.5
15-25
6.0-8.2
135-145
3.5-5.0
22-29
95-107
8-21
0.5-1.4
30-125
12
3-44
8
0-40
0.5
275
0.2-1.3
< 200
BNP (Brain Natriuretic Peptide Test)
Patient
Reference Range
350 H
0-99 ng/L (nanograms/Liter)
Charles Jones – Lab and Diagnostic Tests
Date: Yesterday
Chest Xray: Impression: Bilateral congestion in the lower lungs.
Enlarged heart
Peter Wilkes, MD, Radiology
Date: Yesterday
Echocardiogram: Impression:
Moderately enlarged left ventricle
Ejection Fraction 35%
(Normal is 55-65%)
James Allen, M.D. Cardiology
Yesterday:
12 Lead Electrocardiogram: Impression:
Atrial Fibrillation
James Allen, M.D. Cardiology
Medications:
Metoprolol 50 mg PO daily
Coumadin 5 mg PO daily
Aspirin 81 mg PO daily
Lasix 40 mg PO BID