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you also have to have a high quality post from a content perspective. This means it also needs to do more than agree with or praise a class mate. If you agree with a classmate, explain why, give an example, share what you learned in the readings
Nursing interventions appropriate for Mrs. J. at time of her admission:
The initial goal is to stabilize Mrs. J’s. condition. We want to provide conservative measures that will improve her comfort and condition to avoid mechanical ventilator support. This includes medications and oxygen. Nursing interventions would include, monitoring blood pressure, heart rate, respiratory rate and status, auscultating lung and heart sounds, placing IV or obtaining IV access. Placing patient on telemetry and providing oxygen and medications as ordered. Calming and reassuring the patient, informing patient what is being done and why, and obtaining further medical and allergy history. Check Lab work such as BNP, CPK, and troponin to check for fluid overload and cardiac muscle deterioration, electrolytes should be monitored and checked frequently, especially potassium and sodium levels due to Lasix. Monitor strict I&O to check for fluid balance, and place an indwelling Foley catheter for accurate output measurements.
Rationale for the administration of each of the following medications:
- IV furosemide (Lasix) is given to alleviate her respiratory symptoms. Mrs. J. has a history of chronic heart failure and presents with shortness of breath. Her SpO2 is 82% and pulmonary crackles were heard. Lasix is a diuretic and helps treat fluid retention in people with congestive heart failure (CHF), (Brywczynski 2010).
- IV Enalapril (Vasotec), is an angiotensin converting enzyme (Ace inhibitor). It is used to treat high blood pressure and congestive heart failure. It is also used to treat a disorder of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart (Enalapril uses and dosages,Drugs.com). This disorder can decrease the heart’s ability to pump blood to the body. Mrs. J. has symptoms of CHF; this is why Enalapril was ordered for her.
- Metoprolol (Lopressor), is a beta-blocker and is used to treat chest pain and hypertension. It is also used to treat or prevent a heart attack. It can be used to treat atrial fibrillation, which Mrs. J. has according to the initial cardiac monitoring, indicating a ventricular rate of 132 and atrial fibrillation.
- IV Morphine sulfate (Morphine), is an opioid and usually used for pain but it can also be used to treat “air hunger” Patients with respiratory distress due to acute pulmonary edema in heart failure will have a significantsympathetic response , including increased blood pressure and heart rate (Brywczynski 2010).
Describe four cardiovascular conditions that may lead to heart failure (American Heart Association, 2016):
Heart failure is the inability of the heart to pump a sufficient amount of blood to adequately perfuse the body to meet its metabolic needs. Heart failure is common as people age, and is usually a result of years of added stress due to health conditions that damage the heart or make it work too hard. Poor lifestyle habits like smoking, being overweight, eating foods high in fat and cholesterol and physical inactivity increases your risk of heart disease, heart attack and stroke. Hypertension, prior myocardial infarction (MI), valve disease or longstanding obstructive lung disease can also lead to heart failure being overweight, eating foods high in fat and cholesterol and physical inactivity – can also contribute to heart failure (American Heart Association, 2016).
- Hypertension (HTN): When pressure in the blood vessels are high, the heart has to pump harder than normal to keep the blood circulating. This takes a toll on the heart, and over time the chambers get larger and weaker.
- Myocardial Infarction (MI): Past heart attack (myocardial infarction)
A heart attack occurs when an artery that supplies blood to the heart muscle gets blocked. The loss of oxygen and nutrients damages the heart’s muscle tissue – part of it essentially “dies.” The damaged heart tissue does not contract as well which weakens the heart’s ability to pump blood.
- · Abnormal heart valves : Heart valve problems can result from disease, infection such as endocarditis or a defect present at birth. When the valves don’t open or close completely during each heartbeat, the heart muscle has to pump harder to keep the blood moving. If the workload becomes too great, heart failure results. Heart muscle disease can also cause the heart to overwork and cause heart failure such as; (dilated cardiomyopathy, hypertrophic cardiomyopathy) or inflammation (myocarditis).
- · Coronary artery disease : When cholesterol and fatty deposits build up in the heart’s arteries, less blood can reach the heart muscle. This build-up is known as atherosclerosis. Blood flow can become totally obstructed, causing a heart attack. Coronary artery disease can also contribute to having high blood pressure which, over time, may lead to heart failure.
- Severe lung disease or sleep apnea : When the lungs don’t work properly, the heart has to work harder to get available oxygen to the rest of the body. Sleep apnea is also a risk factor for such medical problems as high blood pressure, heart failure, diabetes and stroke.
What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition American Heart (Association 2016) .
Hypertension: Eat a well-balanced low salt, low fat diet. Maintain a healthy weight. Become more active and exercise daily. Physical activity not only helps control blood pressure it helps you manage your weight, strengthen your heart and lower your stress level. Take your antihypertensive medications daily and properly. Check with your doctor or pharmacist regarding over the counter medications, such as decongestants that can have interactions with your medications. Know how to check your blood pressure and check it daily at rest.
Myocardial Infarction (MI) and Coronary artery disease (CAD): Good nutrition, weight management and physical activity. Get your cholesterol checked. Maintain a healthy lifestyle by avoiding smoking and alcohol. Manage high blood pressure.
Abnormal heart valves: Can be congenital, caused by virus or infection. Inform your patient to let doctor or dentist know of your risk prior to any dental or oral procedures or surgery. Will need antibiotic before procedure to prevent endocarditis. Promote good oral care to prevent tooth decay and abscesses that may lead to infections. Cardiomyopathy is when the heart muscle becomes enlarged, thick or rigid, and in rare cases the muscle tissue is replaced with scar tissue. These patients also need a healthy, low fat, low cholesterol, low sugar diet, Weight management and weight loss. As with all cardiac prevention; exercise and healthy lifestyle to prevent further cardiac complications.
Taking into consideration 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 intervention you recommend. Regina M. Phillips (2011):
- Education: Provide information and education to older patients and their caregivers about the medications and supplements used. Reviewing what the medications are for, and their possible side effects can prevent adverse drug reactions. It prevents misunderstandings and confusion regarding the medication and its side effects and possible interactions with other medications and herbal supplements.
- Compliance: Encourage older adults to use the same pharmacy group for medication needs so that a comprehensive, computerized medication profile can be maintained and potential medication duplication or other adverse drug events (ADEs) can be avoided. When multiple healthcare providers prescribe multiple medications, it’s known as polypharmacy. This might be done for several reasons, but the main reason is that older patients tend to visit several different physicians or nurse practitioners; one provider may be unaware of medication recommendations made by another, leading to unintentional polypharmacy.
- Monitoring of medications. Some older adults have insufficient financial reserves or inadequate or no insurance to pay for all necessary medications. They may make some medications last longer by “stretching” the doses to save money. Some might eliminate the medication completely because they’re too costly. Others might purchase medications from less expensive Internet pharmacies or from other countries. Although these medications may be cheaper, medications from these sources may not contain the same pharmacologic components as drugs manufactured in the United States or from more customary pharmacies and could be harmful and potentially deadly.
- Advocate: Advocate for older patients. Investigate non pharmacologic treatment measures, as well as less frequent medication dosing or a simplified medication regimen whenever possible. Ask doctor questions regarding why they are taking the medications and if it is truly needed when applicable. Tell patient to follow up with their physician regularly and notify the doctor of any changes with medications, supplements or diet.