Heart failure is a clinical syndrome caused by structural and functional defects in the myocardium which results in the impaired ventricular filling and the ejection of blood (Inamdar &Inamdar,2016). Based on the functional status of the heart, heart failure can be classified as heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). 
Based on the cardiac output, HF can also be classified as a high-output failure and low-output failure (Inamdar &Inamdar,2016). High-output failure can be caused by anemia, vascular shunting, hyperthyroidism and vitamin B1 deficiency. Low-output heart failure is characterized by insufficient forward cardiac output and is much more common than the high-output heart failure. Mrs. J has clinical symptoms of biventricular heart failure which is characterized by poor cardiac output-forward failure, and congestion of the blood behind the pumping chamber-backward failure (Copstead-Kirkhorn,& Banasik, 2014). 

The patient is very anxious at this time based on the kind of questions that she is asking, and her oxygen saturation level at 82% is increasing the workload of the heart. Supplemental oxygen therapy should be started to compensate by decreasing the heart’s workload, increase oxygen delivery to the body tissues to prevent serious damage to the brain and other vital organs. Patient need to be reassured that the medical team is making every effort necessary to take care of her symptoms. This first interventions will help reduce her anxiety and get her mind focused on getting better. This should be followed with continuous monitoring of her vital signs, paying close attention to ECG readings, heart rate and rhythm, blood pressure,  intake and output, further lab works and results as ordered and following other prescribed therapies as ordered. (Amakali, 2015).
The patient’s smoking issue need to be addressed as well starting from admission. Patient admits to smoking 40 cigarettes a day. She need to know that she may not be allowed to smoke while admitted in the hospital.Tthe doctor may order alternative to smoking such as nicotine patch to provide some support for the patient and start the process of smoking cessation.The dangerous effects of her smoking would need to be explained to her through a comprehensive teaching program prepared while in the hospital and prior to discharge.

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