What nursing interventions are appropriate for Mrs. J. at the time of her admission?
1.Oxygen – increase O2 circulation
2.Administer diazepam or any anxiolytic as ordered. This will enable the patient to calm down
3.Low stimuli environment – pt is anxious
4.TED hose and SCDs – reduce edema, increase circulation
5.Non-slip socks, bedside commode, fall precautions – diuretic will have her up often to use the restroom; pt is high fall risk
6.Incentive spirometer – remove fluid from lungs to prevent/reverse pneumonia
7. Chaplin – further calm anxious pt
Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?
Medications:
IV furosemide (Lasix): It reduces extravascular volume by inducing diuresis hence decrease preload and the work of the heart in pumping blood hence prevent progression of heart failure. That is Lasix is a diuretic that releases excess fluid, thus reducing strain on the circulatory system (Howard, 2001).
Enalapril (Vasotec): This medication is an antihypertensive which causes vasodilation of peripheral vessels decreasing afterload resistance hence effective in heart failure. Its help to lower blood pressure, increase cardiac output and exercise tolerance without changing the heart rate (Gierrthmuehlen, 2016).
Metoprolol (Lopressor-it’s a beta blocker and usually used to treat high blood pressure, chest pain, and heart stress after a heart attack due to its antagonistic effect on of beta receptors on the heart. It slows the heart rate, allowing the left ventricle to fill more completely. The slowing of the heart (or the conduction through the AV nodes) helps to regulate A fib. A slower heart rate will assist the pt to feel less anxious.
IV morphine sulfate (Morphine) is a narcotic analgesic use to manage pain. It also increases O2 supply to the heart while decreasing the heart’s O2 demand.
Describe four cardiovascular conditions that may lead to heart failure
High blood pressure- Uncontrolled BP is a high-risk factor for developing CHF. When pressure is blood vessels is too high the heart has to pump harder than normal to keep up, and over time it causes the heart to get weaker.
Nursing interventions:
Ensure all home medication is on the MAR. Verify the medications with MD and adhere to BP protocol ordered by MD.
Education is the key: Educate pt to be compliance with all medications ordered by MD.
Smoking is a major risk factor for the development of coronary heart disease. CAD is a leading cause of heart failure and also the death of some part of the heart muscle.
Nursing interventions
Educating on smoking cessation and the risk factors associated with it will help prevent heart failure and lung cancer. Nicotine patches is essential for all smokers. It assists in smoking cessation.
Obesity-: This is another problem that increases heart failure. Overweight’s cause the heart to work harder than normal and cause sleep apnea.
Nursing interventions:
Exercise and proper diet help manage obesity. Educating on the long-term effects of obesity and some ways to help with weight loss.
Sleep apnea- Pauses in breathing can contribute to fatigue and cause high blood pressure and heart failure, diabetes, stroke.
Nursing interventions
Encourage patients to use their prescribed CPAP.
Educate on the importance of CPAP and risks of noncompliance.
Cardiomyopathy: That is enlarged heart muscles (either due to increased workload over time, or genetic abnormalities), require more oxygen and energy to efficiently pump blood through the heart (Ottaviani, 2016). Enlarged walls of the heart chambers also decrease the size of the chamber, which reduces the amount of blood that can fill the heart at any given time.
What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition?
1.Monitoring blood pressure-this will prevent heart from overworking
2.Blood sugar monitoring and advice on diet to decrease blood sugar
3.Cholestrol level monitoring-to reduce chance of getting coronary artery disease
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.
1. Help and educate the patient on keeping an accurate log and list of all medications and herbal medication that the patient is on. This will assist in drug interactions.
2. Educate the patient on the importance of choosing one primary care physician to reduce polypharmacy.
3. Help and educate the patient on ensuring proper dosage and frequency by using medication organizer if patient unable to read.
4. Educate the patient on possible interactions of herbal medication and the need to inform the physician of all herbal medication.
5. Ensure the patient is educated on all new medications, indications, education, potential side effects, and potential interactions.
References
American Nurses Association. (2017). Preventing polypharmacy in older adults. Retrieved August 2017, from https://www.americannursetoday.com/preventing-polypharmacy-in-older-adults
Davis’s Drug Guide. (2016). Morphine. Retrieved August 15, 2017, from https://www.drugguide.com/ddo/view/Davis-Drug-Guide/51518/all/morphine
Davis’s Drug Guide. (2016). Morphine. Retrieved August 15, 2017, from https://www.drugguide.com/ddo/view/Davis-Drug-Guide/51518/all/morphine
Plos Ottaviani, G., Segura, A. M., Rajapreyar, I. N., Zhao, B., Radovancevic, R., Loyalka, P., & Buja, L. M. (2016). Left ventricular noncompaction cardiomyopathy in end-stage heart failure patients undergoing orthotropic heart transplantation. Cardiovascular Pathology, 25(4), 293-299. doi:10.1016/
RX List. (n.d.). Vasotec (Enalapril) Drug Information: Indications, Dosage and How Supplied – Prescribing Information at Rx List. Retrieved August 15th, 2017, from http://www.rxlist.com/vasotec-drug/indications-
