What nursing interventions are appropriate for Mrs. J. at the time of her admission?
Nurses are the primary contact with the patients and play a significant role in patient recovery. For Mrs. J, the nurse's primary intervention can be informed by her previous medical history and evident symptoms when she arrived in the hospital. Patients at risk of heart failure require a highly objective intervention to manage their symptoms and improve their health (Riley, 2015). In this case, creating an appropriate care environment to manage the patient and initiating general assessment should be the primary actions of the nurses to manage Mrs. J symptoms. Once in a critical care environment such as an intensive care unit, the nurses should evaluate the patient current limitations and discomfort such as breathlessness and fear and ensure the patient comfort and ability to breathe normally is restored. The nurses should ensure that Mrs. J is comfortable and relaxed and offer primary care of ensuring she has sufficient supply of oxygen and she can breathe effortlessly after which further patient assessment can be carried out to inform on further evidence-based interventions (Riley, 2015). This intervention is based on the subjective data which has indicated that the patient is anxious, breathless and reports of exhaustion. Therefore, the primary objective of the nurse's initial intervention is stabilizing the patient and ensuring proper function such as breathing and normalizing the blood pressure and heart beats.
Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?
1). Furosemide (Lasix)
Furosemide is a diuretic drug that is used to treat edema due to congestive heart failure as well as control mild to moderate high blood pressure which is required in the case of Mrs. J (Oh & Han, 2015). The patient, objective data shows a very low blood pressure of 90/58 and administering furosemide can help attain a moderate blood pressure to ensure that blood is pumped correctly to her body organs.
2). Enalapril (Vasotec)
Vasotec is used in combination with diuretics to treat heart failure and high blood pressure. Vasotec increase the survival of heart failure patients because it helps in the reduction of systemic vascular resistance and increases cardiac output which is what Mrs (Hale & Greiner, n.d). J needs based on the subjective data which shows high exhaustion an indication of insufficient oxygen availability due to low blood pressure. Vasotec is used in heart failure cases to decrease chemicals that tighten blood vessels to allow a smooth flow of blood and ease pressure on the heart to ensure blood is pumped more efficiently.
3). Metoprolol (Lopressor)
Metoprolol is a beta blocker used together with diuretics and ACE inhibitors which helps to reduce mortality by ensuring that the patient is not fluid overloaded (Hale & Greiner, n.d). The drug helps in blocking the actions of natural chemicals in the heart and vessels which help to stabilize blood pressure and reduce strain on the heart which is necessary for heart failure patients such as Mrs. J.
4). Morphine sulphate (Morphine)
Morphine is a sedative which will be necessary in the case of Mrs. J because she will be put in a mechanical ventilator to help ease her breathing. During the insertion of the endotracheal tube, patients require to be sedated to increase tolerance and to improve the patients to stay in one location while ensuring optimization of oxygenation (Agewall, 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.
Heart Muscle Disease (Cardiomyopathy)
The diseases that affect the heart muscle pose a significant threat to the functioning of the heart and can lead to heart failure. Cardiomyopathy leads to the enlargement or rigidity of the heart muscle (Dunlay et al., 2009). Cardiomyopathy can be managed by educating the patient to change their lifestyles by avoiding strenuous activity, and in advanced cases surgery or implantation of a device to correct arrhythmias is necessary.
Endocarditis (Abnormal Valves)
The valves of the heart play a significant role in the circulation of blood and functioning of the heart. Defective valves pose a substantial threat to the heart because of increased pressure on the heart to maintain blood flow (Dunlay et al., 2009). Nursing intervention in such a case involves lifestyle education to change behavior that could increase pressure on the heart leading to heart failure. Patients with abnormal heart valves should be relaxed and avoid strenuous activities.
High Blood Pressure (Hypertension)
Hypertension is a condition that increases the risk of heart failure due to increased pressure on the heart to pump more blood than usual. The heart chamber due to high blood pressure becomes large and weak which leads to heart failure (Dunlay et al., 2009). Nursing interventions such as relaxing the patient and medications that maintain a lower blood pressure can help to prevent heart failure in patients with hypertension.
Coronary Artery Disease
The buildup of fats and cholesterol on the arteries of the heart can reduce the amount of blood reaching the heart muscles. In such cases, patients experience extreme pain, and total obstruction of the arteries can lead to heart failure or heart attack because the blood does not reach the heart muscles (Dunlay et al., 2009). Nursing intervention in the case of coronary heart disease involves the education of patients to avoid fatty foods as well as exercises that can help improve blood flow to the heart muscles.
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.
Drug interactions, especially for adults who take multiple drugs, can be detrimental to the health of the patient. Nurses have a role in creating and implementing interventions to reduce possible interactions. The information, instruction, and organization are steps that the nurses can use to prevent drug interactions. Nurses should ensure that each medication is correctly identified, the potential interactions and ensure that the patients take medications at the right time to avoid a possible collision. Nurses should organize drugs well and educate the patients on how to store medicines to avoid possible sharing and confusion (Edwards & Axe, 2015). Therefore, through instructions, organization and information provision nurses can be able to prevent drug interactions in older patients.
Agewall, S. (2017). Morphine in acute heart failure. Journal of thoracic disease, 9(7), 1851.
Dunlay, S. M., Weston, S. A., Jacobsen, S. J., & Roger, V. L. (2009). Risk factors for heart failure: a population-based case-control study. The American journal of medicine, 122(11), 1023-1028.
Edwards, S., & Axe, S. (2015). The 10 'R's of safe multidisciplinary drug administration. Nurse Prescribing, 13(8), 398-406.
Hale, G., & Greiner, L. (n.d). Beta-blockers Versus ACE Inhibitors in Heart Failure with Reduced Ejection Fraction: Which Should be Utilized First?
Oh, S. W., & Han, S. Y. (2015). Loop diuretics in clinical practice. Electrolytes & Blood Pressure, 13(1), 17-21.
Riley, J. (2015). The Key Roles for the Nurse in Acute Heart Failure Management. Cardiac failure review, 1(2), 123.
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