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Acute decompensated heart failure (ADHF) is the primary admitting diagnosis for more than one million patients per year and is the most common cause of hospital admissions in individuals over sixty-five years of age (Fermann & Collins, 2013). Initial interventions that take place when a patient is admitted into the hospital with acute heart failure includes interventions to relieve symptoms and interventions to begin therapy. The patient must be triaged swiftly and appropriately to ensure safe clinical care. At all times healthcare providers must ensure the patient and their family is informed on the clinical care decisions taking place (Riley, 2015). It is imperative to take measures to aid in lessening the patients anxieties by fulling explaining all interventions to the patients. To guide therapy many tests may be prescribed. These tests include blood tests, echocardiogram, and an EKG.
Most commonly the patient would be started on a non-potassium sparing diuretic administered intravenously (IV) to remove excess fluids (Riley, 2015). Nitroglycerin which is a potent venous and arteriole vasodilator should be initiated. The IV form can be titrated based on the patients blood pressure and symptom response (Fermann & Collins, 2013). Although, the administration of IV Nitroglycerin often follows a strict protocol that must be done in the intensive care unit. Diuretics must be administered to remove excess fluids. Nesiritide is approved for the treatment of ADHF and improves hemodynamics along with dyspnea. Angiotensin-converting enzyme (ACE) inhibitors maybe administered for pulmonary vasodilation (Fermann & Collins, 2013). Oxygen supplementation may be prescribed. All therapies must be monitored objectively to promptly address changes in clinical status and how the pateitns is responding to treatment (Fermann & Collins, 2013).
The drugs IV furosemide (Lasix), Enalapril (Vasotec), Metoprolol (Lopressor) and IV morphine sulphate (Morphine) were prescribed to a patient that was admitted to the hospital for (ADHF). IV furosemide (Lasix) is used to aid the body in excreting excess fluids and sodium which makes it easier for the heart to pump and controls blood pressure. Enalapril (Vasotec) is used to relax and dilate blood vessels and lower blood pressure. This improves blood flow and enables the heart to pump more blood to the rest of the body without having to work as hard. Metoprolol (Lopressor) is used to improve the hearts ability to relax, decrease the production of substances the body makes in response to heart failure, slows the heart rate and, improves the hearts pumping ability over time. IV morphine sulphate (Morphine) is used to relieve dyspnea, levels of anxiety, and help the patient rest (Levey & Bellou, 2013).
There are many cardiovascular conditions that may lead to heart failure including hypertension, atherosclerosis, carditis, and disorders of the heart valves. Health care providers are imperative in aiding individuals in making sure these cardiovascular conditions do not lead to a future diagnosis of heart failure. In the case of hypertension health providers aid their patients in controlling their blood pressure by regular assessment of the patients blood pressure and heart rate. Antihypertensives are often prescribed, education is of most importance in the treatment of hypertension. Health care providers must ensure they provide education on a healthy lifestyle which includes a healthy diet that reduces sodium, daily activity, and not smoking. To aid in the prevention of heart failure from atherosclerosis patients cholesterol level must be routinely monitored. Education must be provided on the importance of heart healthy low-fat diet and daily exercise. Individuals will often be prescribed statin drugs to lower their cholesterol levels, and healthcare providers must ensure to educate their patients on its effects. The health provider needs to also access the patients weight and provide aid in weight loss if necessary.
The best way to prevent carditis from turning into heart failure is preventing carditis from ever occurring. To prevent carditis health care providers must access that patients are up to date on their vaccinations for diphtheria, tetanus, measles, rubella and polio. Education must be provided to patients on the importance of seeking treatment for infections, especially those of the upper respiratory system. The prevention of heart disease from disorders of the valves is the same as carditis, which is to prevent the valve disorder from ever occurring. To prevent valve disease patients must be educated in the importance of seeking care for infections especially strep throat infections which can easily turn into rheumatic fever. Rheumatic fever damages heart valves. Education on a heart healthy diet and daily exercise along with medications that lower cholesterol can aid in the prevention of aortic stenosis.
Polypharmacy refers to the effects of taking multiple medications simultaneously to manage coexisting health problems. Problems arise when a patient is prescribed medications from multiple health providers whom are not communicating with each other and does not know the patients complete medication picture (Greenawalt, 2009). Nurses are pivotal in aiding older patients in managing their medication and therefore preventing polypharmacy. Nurses must educate their pateitns on the generic and brand names of all their medications as well as why they are taking these medications. Patients whom are well informed on their medications have been found to make less medication errors. Patients should be taught to bring all medications to all medical appointments which reduces confusion over discontinued drugs or dosage changes. Patients should be educated that it is best to limit their health providers if possible which reduces the risk of polypharmacy. If the patient does have to see a specialist then they should be educated to ask for a discharge instruction page and bring that to their next primary care visit (Greenawalt, 2009). Nurses also must advise patients to report all over the counter or herbal supplements they are taking to their primary care provider which will reduce prescribed drugs, over the counter drugs, and herbal supplements from causing harmful drug interactions with each other.
Fermann, G. J., & Collins, S. P. (2013). Initial management of patients with acute heart failure. Heart failure clinics, 9(3), 291-301.
Greenawalt K. (2009). How are all those medications affecting your older patient?: Learn about the risks of polypharmacy and how you can minimize them. Nursing, 39(5), 39.
Levy, P. D., & Bellou, A. (2013). Acute Heart Failure Treatment. Current emergency and hospital medicine reports, 1(2), 10.1007/s40138-013-0012-8.
Riley J. (2015). The Key Roles for the Nurse in Acute Heart Failure Management. Cardiac failure review, 1(2), 123-127.
