What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

At time of admission, Mrs.J we would place her in semi fowlers position, with appropriate oxygen. We would take vitals, get lab values prior to starting IV antibiotics. We would get lung x-ray to evaluate the lungs. Provide her with medication for comfort, reduce anxiety and possible a nicotine patch. This may help with some of the anxiety. We need to watch the fluid, carefully watching the infusion of IVs so we do not have fluid overload. Apply SCD’s to help with circulation. Make sure patients room is quiet, free of clutter and make sur you round the patients room regularly so that you can assist with toileting and to ease the fear of the patient. ( American Heart Association, 2017).

·          The medications order are as follows:

IV furosemide (Lasix) Treating heart failure with a diuretic helps to remove water and salt from the body by causing you to urinate more frequently, and also takes the pressure off the heart by allowing it to pump easier. Diuretics help to reduce swelling.

Enalapril (Vasotec)- This is an ace inhibitor. Ace inhibitors relax the blood vessels. It allows the blood to flow smoothly, making the heart work easier

Metoprolol (Lopressor)- Metoprolol is a beta-blocker. Beta-blockers reduce the workload on the heart and help it to beat more regularly.   This helps with atrial fib and hypertension.

IV morphine sulphate (Morphine) For heart patients it is often used for shortness of breath. It lowers the breathing rate, widens blood vessels in arms and legs (making heart work less hard), reduce the amount of anxiety and anxiousness by breathing more calmly, and it reduces any pain which also removes the anxiety which reduces the respiration rate. (American Heart Association, 2017).

·          Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Cardiac tamponade, also known as pericardial tamponade, is when fluid in the pericardium builds up and results in compression of the heart. The doctor would need to remove the fluid from the pericardial sac. This would relieve the pressure on the heart. As a nurse recognizing the symptoms of anxiety and restlessness, low blood pressure, weakness, chest pain radiating to your neck, shoulders, or back, trouble breathing or taking deep breaths, rapid breathing, discomfort that’s relieved by sitting or leaning forward, fainting, dizziness, and loss of consciousness: will be good to pass on the doctor. ( UpToDate, 2017).

Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits. The buildup of plaques can cause reduced blood flow to your heart. A heart attack occurs if plaques formed by the fatty deposits in your arteries rupture. This causes a blood clot to form, which may block blood flow to an area of the heart muscle, weakening the heart’s pumping ability and often leaving permanent damage. If the damage is significant, it can lead to a weakened heart muscle. A nurse can educate about prevention and control many coronary heart disease risk factors with heart-healthy lifestyle changes and medicines. The risk factors you can control include high blood cholesterol, high blood pressure, and overweight and obesity. (Mayo Clinic, 2017)

Cardiomyopathy happens when the heart muscle becomes enlarged, thick, or rigid. In many cases, you can’t prevent cardiomyopathy. Let your doctor know if you have a family history of the condition. Nurses can educate on how to reduce your chance of cardiomyopathy and other types of heart disease by living a heart-healthy lifestyle and making lifestyle choices such as: avoiding the use of alcohol or cocaine, controlling high blood pressure, high cholesterol and diabetes, eating a healthy diet, getting regular exercise, getting enough sleep, reducing your stress. (Mayo Clinic, 2017)

High Blood Pressure- Blood pressure is the force of blood pushing against the walls of the arteries. If this pressure rises and stays high over time, it can weaken your heart and lead to plaque buildup. Nurses can educate patients on maintaining a healthy weight, getting regular exercise, reduce salt intake, drink alcohol in moderation, and try to reduce stress. Taking prescribed medications to help reduce blood pressure. (Mayo Clinic, 2017)

All heart conditions can be helped to be avoided by regular blood pressure checkups, Cholesterol labs done regularly and standard CBC with Dif panels done to make sure glucose levels are appropriate. (Mayo Clinic, 2017)

·          Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

Nursing interventions that will help with polypharmacy are having patients make a list of all their medication and carry them in their wallet so they do not get prescribed the same type of medications from a different doctor. Encourage all patients to write down all their over the counter medications that they take, because some over the counter medications can interfere with the prescribed medications. Have patients write down all herbal supplements that they take. These too have have adverse reactions with the prescribed medications. Have patients be aware of what they are taking and why. They should be allowed to have adequate time to discuss all their medications. (Mayo Clinic, 2017)

American Heart Association. (2017).   The Facts About High Blood Pressure. Retrieved from https://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/The-Facts-About-High-Blood-Pressure

Evidence-Based Clinical Decision Support at the Point of Care | UpToDate. (2017). Treatment of acute decompensated heart failure: Components of therapy. Retrieved from http://www.uptodate.com/contents/treatment-of-acute-decompensated-heart-failure-components-of-therapy

Mayo Clinic. (2017). Heart failure Why choose Mayo Clinic – Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/heart-failure/care-at-mayo-clinic/why-choose-mayo-clinic/con