Nursing discussion
Re:Topic 3 Mandatory Discussion Question
Based on the patient condition of acute decompensate heart failure, the nursing interventions for include having the patient have supplemental oxygen and continuous positive airway pressure (CPAP) related to the patients’ health history of sleep apnea and has been a lifelong smoker. The patient will need breathing treatments as needed and continuous pulse oximeter monitoring. Moreover, Mrs. J will need a chest x-ray, electrocardiography, and follow lab tests from CBC, CMP with focus towards BNP with normal levels to be < 100 pg/ml with regards to patients Atrial fibrillation and possible rapid ventricular rate (Held, 2009; Ellis, 2017). Management of the condition involves four main hemodynamic drug modalities which include beta-blockers, vasodilators, diuretics, and ACE inhibitors. Likewise, for HF patients they may receive medications such as IV nitroglycerin and in need of cardiac monitoring and if the condition escalates may need to be transfer to a critical care setting. Moreover, the patient should be on restrict fluid and low sodium diet and close monitoring of I&O, foley measurements and electrolyte.
Furosemide (Lasix) is a loop diuretic to control the symptoms of heart failure. Primarily in conjunction with a low sodium diet, it is the first line of therapy for HF patients and particular with this ADHF patient which “because of greater and more consistent bioavailability of the drug. Diuretic dosing should be individualized, although common initial doses of loop diuretic agents in patients with normal renal function include furosemide (40 mg, intravenously)” (Joseph et al., 2009). Enalapril (Vasotect) is a ACE-inhibitor are often considered another medication to implement as a initial therapies to be implemented regarding heart failure by decreasing blood pressure, aldosterone secretion, sodium, and fluid loss (Joseph et al., 2009). Metoprolol (Lopressor) decrease myocardial oxygen demand, in doing so by improving the patients activity tolerance as well as improving the ejection fraction. It does so by reduction of the hearts excitability, reducing the cardiac workload through decreasing renin section and thus the blood pressure (Joseph et al., 2009). IV Morphine Sulphate decreases preload and afterload which in turn lowers cardiac workload. It is important to monitor VS, with caution of use related to respiratory depression and possible dependence. Monitoring I&O and encouraging breathing exercises (Joseph et al., 2009).
ADHF patients have sign and symptoms of which include “hypotension, worsening renal function, or altered mental status should be considered high risk and hospitalized, dyspnea, tachypnea, or hypoxemia (again, oxygen saturation of <90%) at rest,” and can include “hemodynamically significant arrhythmia, including atrial fibrillation with rapid ventricular response, warrant hospital admission—as does any patient who presents with evidence of an acute coronary syndrome” (Joseph et al., 2009).
According to the American Heart Association is involve coronary artery disease, hypertension, heart disease like myocarditis/cardiomyopathy, and abnormal heart rhythm (arrhythmia or dysrhythmia) (American Heart Association, 2017). When it comes to coronary artery disease – cholesterol build up (atherosclerosis) that’s reducing blood flow and oxygen to heart which can lead to the develop of HF. Smoking cessation, low sodium diet and reduction of cholesterol based foods, and increase activity. Uncontrolled hypertension is another problem through which can develop through the blood vessel’s increasing cardiac workload with the vessels weakening overtime. Following prescribed BP medications with regards to alongside reduction in unhealthy diet, increase in physical activity, stress, and decrease in alcohol consumption are steps to follow. Conditions of cardiomyopathy will need close monitoring as it may not be apparent. However, treatment include that of healthy diet, physical therapy, healthy weight management, reduction in stress, and compliance with BP medications such as ACE, ARB, beta blockers, and calcium channel blockers (American Heart Association, 2017). Abnormal heart rhythms such as arrhythmia especially with patients that have Afib are managed through the following, “reduce high blood pressure, control cholesterol levels, lose excess weight, eat a heart-healthy diet, avoid tobacco smoke, and enjoy regular physical activity” (American Heart Association).
As nurses, accurate listing of the drugs and following the 8 right of medication administration provides a cohesive list that provides the nurse a comprehensive understanding and check on all medications to be given. Polypharmacy is a major issue and as such includes patient education of when to take them as a means of medication compliance. This also follows patients bringing in unverified medication that is old or usages of alternative herbal therapies that may have contraindications. Patient needs to know that such medications may have severe adverse to medications she is taken whilst being hospitalized. Lastly, patients should understand that the full dosage must be taken as taking partial dosages reduce patient outcomes as the full treatment is not being met.
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