Please respond with a paragraph to the following post, add citations and references:
What nursing intervention are appropriate for Mrs. J at the time of her admission?
* Begin with H&P questions and obtain vital signs
* Administer O2 with low sats
* Assess lung sounds and for areas of congestion
* Obtain EKG
* Order initial lab tests (CBC, BMP, BNP and NT-pro BNP, urinalysis and electrolytes)
* Manage patient anxiety
What is the Rational for administration of medications?
1. IV furosemide (Lasix)
* Increases renal excretion of water, sodium, chloride, magnesium, potassium and calcium*
* Loop diuretic that inhibits absorption of sodium and chloride ions
* Reduces extravascular volume by inducing diuresis and decrease preload and work of heart. Decreases edema, pleural effusion and possibly blood pressure (Drug Guide.com, 2018).
2. Enalapril (Vasotec)
* Angiotensin II is a neurohormone, or chemical messenger, which helps control the cardiovascular system.
* Antihypertensive which causes vasodilation of peripheral vessels decreasing afterload resistance and effective in heart failure.
* ACE inhibitors, like enalapril, block angiotensin I from being converted to angiotensin II, which essentially allows the blood vessels to relax and expand leading to lower blood pressure
* The use of ACE inhibitors will increase potassium levels in the blood and positively offset the use of Lasix (Drug Guide.com,2018)
3. Metoprolol (Lopressor)
* Treats high blood pressure, chest pain (angina), and heart failure.
* Relaxes blood vessels and slowing heart rate, which improves blood flow and lower blood pressure.
* Beta blockers (Metoprolol) blocks these beta-1 receptors from allowing the attachment of hormones so that the autonomic response system does not illicit responses of increased heart rate, pumping force and blood pressure.
* Blocks the beta cells and controls heart rate, decreased pumping action, and decreased blood pressure.
4. IV Morphine Sulphate (Opioid)
* Reduces anxiety and decreases work load of breathing
* Decreased sympathetic nervous system response
* Morphine can cause relaxation of arterial and venous dilation
* Decreased filling pressures
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.
Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits (plaque) in your arteries, which reduce blood flow and can lead to heart attack.
High blood pressure (hypertension). If your blood pressure is high, your heart must work harder than it should to circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff or too weak to effectively pump blood.
Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve due to a heart defect, coronary artery disease or heart infection forces your heart to work harder, which can weaken it over time.
Diabetes. High blood sugar can damage inside walls of heart muscle. A fatty substance called plaque can begin to collect in arteries and slows down blood flow. This means the heart must work harder to get oxygen and blood flow to areas of the body. Also increases risk of arteriosclerosis (Web MD, 2017).
Nursing interventions to prevent development of heart failure in each condition
Initiate lifestyle changes to reduce CAD such as diet, exercise, reduce stress levels and quit smoking.
Interventions to manage hypertension are lose extra weight, monitor blood pressure, exercise at least 30 minutes daily, eat a healthy diet and reduce sodium.
Interventions to manage Diabetes are managing weight, physical activity, control blood glucose levels, healthy eating and know your A1C scores (Web MD, 2017).
Measures to help prevent endocarditis include having regular dental checkups and performing good oral hygiene such as flossing and brushing (mayoclinic.org, 2017).
Four nursing interventions that can help prevent these problems:
1. Review list of prescribed medications with patient and family. Educate patient on why medication has been ordered and discuss dosage and frequency. Keep log of time and frequency of medication and contact information for refill.
2. Teach patient about side effects of medication and what to do if they experience severe problems. Discuss any dietary restrictions with medications.
3. Patients should bring a list of their medications to each medical appointment. This helps physicians and patients stay on the same page about which medications the patient is taking and eliminate confusion regarding discontinued ones.
4. Remind patients to make notes regarding any side effects when starting a new medication and to notify physician with any problems. Physicians can determine if the side effects are normal or if a new medication should be ordered.
Reference
Drug Guide.com, (2018). Furosemide, Enalapril, Metoprolol, Morphine Sulphate. Retrieved from https://www.drugguide.com/ddo/view/Davis-Drug-Guid March 10, 2019
Mayo clinic (2017). Heart Failure symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142March 11, 2019
Web MD, (2017). What does Diabetes do to your heart disease? Retrieved from https://www.webmd.com/diabetes/guide/diabetes-link March 11, 2019
