American Heart Association (2017). Causes of Heart Failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

Demonstrate integrity through the application of relevant codes of conduct and social responsibility within one’s profession.
October 11, 2018
identify the legal issues in one of the scenarios, research those issues, and make recommendations for addressing those issues
October 11, 2018

American Heart Association (2017). Causes of Heart Failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

Discussion 1

Mrs. J. is already diagnosed with congestive heart failure, which occurs in association with other cardiac disorders from a number of different causes (Copstead & Banasik, 2012). Heart failure is the inability of the heart to maintain sufficient cardiac output to optimally meet metabolic demands of tissues and organs and this results in the end stage of most cardiac diseases.

Nursing interventions that are appropriate to Mrs. J. at the time of admission. Considering the clinical manifestations that this patient is presenting with, she is quite sick and the first issue to be addressed is her airway and oxygenation saturation to ensure that she is receiving enough oxygen to the brain and all other parts of the body. She will need to be placed in bed, made comfortable and given reassurance because she is anxious, worried and asking whether she is going to die. Reassurance and company with a staff is important. Her respiratory rate is rapid (34), Blood pressure is 90/58 so intravenous fluids will not be recommended because she has congestive heart failure however, because she is also put on intravenous Lasix, she may need limited intravenous fluids sparingly. She has palpitations with a heart rate of 118. Mrs. J. will be placed in a room that is close to the nurses’ station and full of light because she scared and will need to be watched closely.

Mrs. J. will need a 12 lead EKG after she has been placed in bed, IV access placed, full blood work chemistry and urine collected, a chest x-ray ordered because she is complaining of not getting enough air. Blood cultures will be collected for because she may be having infection as she Pharyngitis. She will also need Arterial blood gas analysis to determine the oxygenation in her blood stream. She is also reported to be anxious, and morphine injection is ordered which helps to calm her down and also helps decrease the heart demand for oxygen. Mrs. J. will need to be given supplementary oxygen because she is complaining of not getting enough air and reassurance continued. Gradually as her condition improves, education about smoking will discussed as a way of helping towards improvement and may be an alternative for smoking such as use of nicotine patch.

The rationale for giving intravenous furosemide (Lasix) is to help in diuresis since she has fluid overload as evidenced by peripheral edema (1+). Enalapril (Vasotec) is given because it is an ACE inhibitor (angiotensin converting enzyme), which helps by blocking a substance in the body that causes the blood vessels to tighten, and as a result, enalapril releases the blood vessels, which lowers the blood pressure and increases the supply of blood and oxygen to the heart. Metoprolol is a beta-blocker that is given because it affects the heart and circulation and is used mostly in hypertensive patients and patients with irregular heartbeats as already noted in Ms. J. With a ventricular rate of 132 and arterial fibrillation. Morphine administration decreases the hear demand for oxygen and also as a sedative for the patient.

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. One of the conditions is Coronary heart disease which is a waxy substance called plague that build inside the coronary arteries and it causes narrowing of the arteries (National Heart, Lung, and Blood Institute, n.d.) thus reducing the flow to the hear muscles and the build- up also makes it more likely that blood clots in the arteries. This can be prevent by taking a healthy diet that low in cholesterol, exercising and also by having regular medical checkups and observing the weight gain to ensure this is controlled.

Arrhythmias occurs when there change of the heart rates or rhythm of the heart and can be due to some beverages like caffeine and drugs like cocaine, amphetamines and marijuana. Education to those who are prone or predisposed to those drugs is the nursing intervention and creating awareness and effects of those substances.

Myocarditis which is the inflammation of the heart muscles can result from infections such as sore throat and other infections. Nursing education for effective treatment and taking of antibiotics is important and those that fall sick need to seek medical attention.

Hypertension will need to be treated and ensure that patients with hypertension take their medications and measure their blood pressure regularly and also minimize consumption of fatty and salty foods, Exercising daily even simple walking for 30 minutes can be helpful.

Taking into consideration the fact that most mature adults take at least six prescription medications, four nursing interventions that can help prevent problems caused by multiple interactions in older patients can be: Clear education and information about medications. Medications need to be accurately listed and there is need to discuss the dosages and the frequency of taking medications. If the patient cannot read, a family member needs to be educated on the medications the patient is taking to ensure proper supervision. Patients need to be informed why they are taking the medications and also and the danger to take an overdose.

“Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems” (Woodruff, 2010). Patients taking many medications need special containers which are clearly labeled with the frequency and times that the medication needs to be taken. Patients will clearly need supervision of the medications they are taking. Patients need to be aware not to share medications and also store medications in a secure dry area away from light to prevent decomposition and loss of potency. Old medications and expired drugs should be disposed.

Color coding of different medications is very important as the patient will keep a memory of the color codes. Most important, physicians and health providers should minimize the number of prescription drugs for older adults and keep dosing schedules simple and also avoid change of medications frequently if possible. Also use of single medicines for the illness than prescribing multiple medications for the same illness or condition.

Reference

Copstead, L.C. & Banasik, J.L. (2012). Pathophysiology (5th ed.). St. Louis; MO.Retrieved from http://evolve.elsvier.com/Copstead

National Heart, Lung and Blood Institute. (n.d.). Heart failure. Retrieved from https://www.nhlbi.nih.gov/health-topics/heart-fail…

Woodruff, K. (2010). Preventing polypharmacy in older adults. American Nurse Today. 5 (10), 1-7, Retrieved from https://www.americannursetoday.com/preventing-poly…

Disccussion 2

  1. What nursing interventions are appropriate for Mrs. J. at the time of her admission?

At time of Admission Mrs. J requires intervention for her breathing. Not only does Mrs. J feel that she cannot get enough oxygen, she reports feeling weak, and extremely anxious, which is all signs of poor oxygenation. With a SpO2 of 82% Mrs. J requires supplemental oxygen. Mrs. J also has blood tinged, frothy sputum which is a sign of pulmonary edema (pulmonary edema, 2018). Along with the decreased breath sounds, pulmonary crackles Mrs. J is not only starting respiratory failure she is also experiencing left sided heart failure and the build up of fluids. Mrs. J needs Lasix to help her body start to get rid of the excess fluid in her system. With a prolonged period without the proper amount of oxygen in the body Mrs. J heart could suffer the consequence. “When metabolic demand for oxygen exceeds supply, the myocardium becomes ischemic, which leads to a dysfunction in cardiac pumping and predisposes to abnormal heart rhythms. If the ischemic episode is severe or prolonged, irreversible damage to myocardial cells may result in MI” (Copstead-Kirkhorn. (2010) page 429)

Mrs. J should get an EKG if it was not already done in the Emergency room to get a good look at the heart. With atrial fibrillation Mrs. J has an increase risk for experiencing a stroke. When listening to the heart S3 sounds are present. S3 sounds could indicate ventricular failure. “The third heart sound (S3), when audible, occurs early in ventricular filling, and may represent tensing of the chordae tendineae and the atrioventricular ring, which is the connective tissue supporting the AV valve leaflets. This sound is normal in children, but when heard in adults it is often associated with ventricular dilation as occurs in systolic ventricular failure” (Heart Sounds, para 3).

Mrs. J has been not taking care of herself for a while and finds herself critically ill. She is feeling anxious due to not being able to breath properly, due to hospitalization, and fear of the unknown. Nurses should do their best to explain everything that they are doing to Mrs. J. short, simple explanations can help a patient feel more at ease about the situation, and put trust in the health care staff caring for them.

  1. 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. IV furosemide (Lasix): Promotes diuresis and the excretion of excess fluid. Used with heart failure patients and with hepatic impairment. We know due to the jugular vein distention, crackles in lungs, pulmonary edema, and other signs and symptoms Mrs. J has that she has excess fluid in her body that her body is unable to get rid of on its own. Lasix helps excrete the fluid. Although the main concerns we were looking at is heart failure, it is indicated that Mrs. J has hepatomegaly, so she may have issues with her liver as well. (Vallerand, Sanoski, & Deglin, 2017)
  1. Enalapril (Vasotec): An ACE inhibitor used in the management of hypertension in patients with heart failure. This medication is used because of Mrs. J’s comorbidities and due to her having heart failure signs and symptoms. (Vallerand, Sanoski, & Deglin, 2017)
  1. Metoprolol (Lopressor): Beta blocker that is used in combination with ACE inhibitors for management of hypertension and is used in patients with heart failure. “Indications Hypertension. Angina pectoris. Prevention of MI and decreased mortality in patients with recent MI. Management of stable, symptomatic (class II or III) heart failure due to ischemic, hypertensive or cardiomyopathc origin (may be used with ACE inhibitors, diuretics and/or digoxin; Toprol XL only)” (Vallerand, Sanoski, & Deglin, 2017).
  1. IV morphine sulphate (Morphine): an opioid analgesic that is usually used for pain. However, morphine can also be used for pulmonary edema. Morphine also helps anxiety and reduces oxygen demand. (Vallerand, Sanoski, & Deglin, 2017).
  1. 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.

1.Atherosclerosis: “Atherosclerosis causes progressive narrowing of the arterial lumen and predisposes to a number of processes that can precipitate myocardial ischemia, including thrombus formation, coronary vasospasm, and endothelial cell dysfunction” (Copstead-Kirkhorn. (2010) page 429) Medications that help with atherosclerosis is statins, aspirin, and angiotensin inhibitors. Nursing interventions include: assisting with smoking cessation, control of diabetes, and dietary changes to promote healthier lifestyle.

2. hypertension: patients should take prescribed blood pressure medication and follow up with primary doctor to determine effectiveness. Nursing interventions include, smoking cessation, instructions on taking medication, and exercise.

3. cardiomyopathy: is enlargement of the heart from infections or drug and alcohol abuse. (“Congestive Heart Failure and Heart Disease”, 2018). Nurses can assist patients in getting rehab for drug addiction and teach a sober lifestyle.

4. valve disease: can increase the work load of the heart which can increase risk for heart failure. (“Congestive Heart Failure and Heart Disease”, 2018) nurses should teach patients to lead active healthy lifestyle and to look for signs and symptoms of heart failure like swelling, and report to primary doctor as soon as signs begin.

  1. 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. Provide rationale for each of the interventions you recommend.
  1. Nurses should assist patients in organizing. Many times, when patients have a lot of medication it is easy to forget to take medication, or can not remember if they took the medication, and they take it again accidently double dosing themselves. Getting a medication organizer can reduce these errors and help patients take their medication as appropriate. (“Preventing polypharmacy in older adults”, 2017)
  1. Technology has greatly assisted in checking for drug interactions. “Advances in information technology, such as electronic prescribing, electronic medical records, and electronic laboratory records, are innovative ways to decrease the risk of adverse drug reactions and interactions” (“Preventing polypharmacy in older adults”, 2017)
  1. Limiting health care providers could help in the safety of medication. When a patient sees a new doctor, they should provide a detailed list of all medications and supplements they are taking. The patient should inform their primary doctor of any medication changes the new doctor wishes to make before implementing the change. (“Preventing polypharmacy in older adults”, 2017)
  1. Nurses should teach patients about any dietary restrictions that their medication requires, and nurses should teach potential side affects so the patient knows what to expect and when to seek emergency care. “Inform patients of any dietary restrictions necessitated by a specific medication. During healthcare appointments, teach the patient about potential side effects, including when to call the clinic or go to the emergency room” (“Preventing polypharmacy in older adults”, 2017)

Reference

Copstead-Kirkhorn. (2010). Pathophysiology, 4th Edition. [Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978141605…

Congestive Heart Failure and Heart Disease. (n.d.). Retrieved June 19, 2018, from https://www.webmd.com/heart-disease/guide-heart-fa…

Heart Sounds. (n.d.). Retrieved June 18, 2018, from http://www.cvphysiology.com/Heart Disease/HD010

Preventing polypharmacy in older adults. (2017, September 19). Retrieved June 19, 2018, from https://www.americannursetoday.com/preventing-poly…

Pulmonary edema: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved June 18, 2018, from https://medlineplus.gov/ency/article/000140.htm

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017). Daviss drug guide for nurses. Philadelphia: F.A. Davis Company. Retrieved June 18, 2018, from search.ebscohost.com/login.aspx?direct=true&db=nrc&AN=2009535797&site=nrc-live.

Discussion 3

Mrs. J’ symptoms are typical of congestive heart failure (CHF), which occurs when the heart cannot provide adequate oxygenation or nutrients to the body. Her presenting symptoms at admission, as well as her cardiovascular and pulmonary findings are of left ventricular failure. Patients often appear anxious, have a productive cough, hypoxia, and an enlarged liver. Her tachycardia, tachypnea, and hypotension are all due to her state of decompensation. Her S3 present with a ventricular rate of 132 and atrial fibrillation are of concern as well.

The decreased cardiac output will be affecting vital organs. Mrs. J is already retaining fluid, thus the need for furosemide. Loop diuretics are used for the symptomatic relief of sodium and water retention. Beta-blockers (metoprolol), and angiotensin-converting enzyme (ACE) inhibitors have been the main medical treatment of choice for CHF for decades. They work by neurohormonal suppression and reducing the ejection fraction (Oni-Orisan & Lanfear, 2014). Digoxin is another drug that could be used but at very low levels. Morphine is usually prescribed in the sickest patients, although recent literature shows it can cause some harm as well (Agewall, 2017). In this case, it was probably used for lowering her heart rate and respiratory rate, but it can also cause respiratory depression.

Acute MI, tachycardia, bradycardia, fluid and salt retention are some conditions that can lead to heart failure. Nurses and physicians must assess patients with these symptoms for any signs of knowledge deficit regarding the causes of their conditions and educate them on the importance of taking their medications as prescribed, to prevent further medical complications. Many of these patients face the issue of polypharmacy. In many cases, if the patient does not have enough money they may choose to take one drug over the other one. I had a patient that stopped taking his blood pressure medicine because at the last visit his BP was normal. I explained to him the reason it was normal it was because of the medication. The risk of drug interaction is one that the nurse should be aware of and be able to review the list of medications with the patient at each visit. She should recommend to the patient to always fill the prescriptions at the same pharmacy, so there is a record of all the medications taken for the pharmacist to be able to contact the prescriber of any drug interactions. The nurse, as a patient advocate, should assess for any financial, economic or social conditions that may keep the patient from taking the prescribed medications and follow-ups in the clinic.

References

Agewall, S. (2017, July, 2017). Morphine in acute heart failure. Journal of Thoracic Disease9(7), 1851-1854. https://doi.org/10.21037/jtd.2017.06.129

Oni-Orisan, A., & Lanfear, D. (2014). Pharmacogenomics in heart failure: where are we now and how can we reach clinical application. Cardiology in Review22(5), 193-198. https://doi.org/10.1097/CRD.0000000000000028.

Discussion 4

The nursing interventions that are appropriate for Mrs. J at the time of her admission is to immediately get her hooked up to a continuous heart rate monitor, have her sit in a high fowler’s position to promote better respirations and keep her calm. It can be a scary thing being admitted to the hospital. Often times when a patient is first admitted, so many things are happening at once, nurses and other health care professionals forget to take a step back and see if the patient is okay, if they have any immediate questions, ease their fears and anxiety and just being a caring hand to hold.

The rationale for initiating IV Lasix is to eliminate the excess water in Mrs. J’s body. According to Ogbru (2018b), when Lasix is administered its function is to block the absorption of water, sodium and chloride by the body. By doing this there is a large increase in urine production. Mrs. J had pulmonary crackles and decreased breath sounds which could indicate she is fluid overloaded.

Vasotec was also initiated for Mrs. J to relieve the symptoms she was experiencing. Vasotec is an ACE Inhibitor. An ACE inhibitor stands for Angiotensin Converting Enzyme Inhibitor. These types of medications enlarge the blood vessels which allows the heart to pump blood easier and lower a person’s blood pressure (Ogbru, 2018a, What are ACE inhibitors and How Do They Work Section). Because Mrs. J is exhibiting signs of worsening heart failure, administering an ACE inhibitor such as Vasotec will allow her heart to pump the blood slower which will improve her hearts overall function.

Lopressor is a beta blocker. A beta blockers job is to block norepinephrine and epinephrine at their receptor sites (Kow & Ong, 2011). By doing this, Mrs. J’s increased heart rate will slow down which means that her heart will be beating with less force.

Morphine was also administered to Mrs. J. When people think of Morphine, they usually think of a narcotic that relieves pain. Although there are not many studies to support it fully, morphine can be given in the early stages of acute heart failure due to its sedative and also hemodynamic properties. Morphine can reduce the hearts oxygen demand by decreasing the preload and heart rate (Coons, McGraw, Murali, 2011, para. 1). Giving Morphine to Mrs. J will not only relax her in this tense and scary situation she is going through, it can also provide more oxygen to her heart by almost relaxing it.

There are many things that can contribute to a person having heart failure. Having coronary artery disease can lead to heart failure. Coronary artery disease is when the arteries of your heart have a build of up cholesterol. This means that less blood is able to flow through freely. This buildup in the arteries can lead to an increase in blood pressure which lead can lead to heart failure (American Heart Association, 2017). Being obese can also be a contributing factor. Because of the excess weight, it causes the heart to work harder compared to a non- obese person. Being a diabetic can also increase a person’s risk for developing heart failure. People who have diabetes, especially Type II diabetes, tend to be overweight, lack physical activity, have an increased cholesterol level and elevate blood pressures (American Heart Association, 2018). All of these things that accompany the diabetes increase a person’s risk greatly for heart disease. Hypertension is another cardiovascular condition that may eventually lead to heart failure. When a person’s pressure within their blood vessels remains high, it means that the heart is having to work much hard to pump the blood throughout the body. If it goes uncontrolled and not properly treated it can cause the chambers of the heart to become much weaker and larger, which then can increase your risk for heart failure (American Heart Association, 2017). Also, if someone has suffered a heart attack before has a much higher risk of developing heart failure compared to others. Having a heart attack damages the muscle tissues of the heart which means that the heart does not contract as easily as it did before making it pumping abilities weaken (American Heart Association, 2017).

To prevent heart failure in patients with each of these cardiovascular conditions the first nursing intervention that should be done is education. If a patient is not properly educated on the reasons they are being treated for the condition they have, on the medication they may be taking, signs and symptoms of heart failure, when they should seek medical attention, and what could happen if they do not treat their cardiovascular condition, it puts them at greater risk. In addition to education, for a person with coronary artery disease, ensuring that they are adhering to a proper diet that can reduce their cholesterol intake and making sure they are taking any medications that they are prescribed. For obesity, assisting with exercise regimens, referring them to support groups and education on consuming a healthy and well- balanced diet to help them to lose weight can decrease their risk of heart failure. For a diabetic patient, making sure that their blood sugars are well controlled, their following a proper diabetic diet, increasing their physical activity and taking their medication as ordered. Patients with Hypertension should check their blood pressure on a daily basis as well as their medication. Checking their blood pressure daily will ensure that they are on the proper medication, it is the right dose and their blood pressures are normotensive. Also, decreasing sodium intake and eating a diet high in fruits and vegetables and increasing physical activity can also decrease their blood pressure without the use of medications. All of these conditions also require that the patients are seeing their doctor on a regular basis and getting any lab tests done that are required.

As a person grows older, more health issues usually arise which means that the older you get, the more medications you are taking. This can sometimes be confusing for the older adult. They can get confused on when to take which pill, how many times a day, if they have to take the pills with food or should they be on an empty stomach, or if any of the medications have interactions with each other. A nursing intervention to prevent drug interactions is medication education. Providing detailed yet easy to understand education on the medication such as what that medication is for, common side effects, when to take it and what to not take it with. Another nursing intervention to go along with the first intervention is to keep an accurate list of each medication. This list should include both the generic names and any brand names it may have, a picture of what the medication looks likes, the purpose of it and the side effects. Keeping a list like this posted on a cabinet door or somewhere where the medications are stored allows the patient easy access to if and when there should be a question about the medication. Sometimes medication bottles can be confusing and the print on them is hard to read. Taking each medication and placing it in a new container labeled largely with the name of the medication, time it should be taken, and what to avoid taking it with on the top is a fool proof way for older patients to not miss taking a dose and avoid taking it the incorrect way. Lastly, another way to reduce the risk for drug interactions is to urge older patients not to share medications. Medications can be very costly. However, sharing medications between friends or family to save money may cost you in other ways. By not sharing medications with others you avoid the risk of overdosing, taking a medication that you are not prescribed, taking a medication that could interfere with another one you are already taking or taking a medication that you could have a allergic reaction to.

References:

American Heart Association. (2017, May 8). Causes of Heart Failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

American Heart Association. (2018, January 29). Cardiovascular Disease and Diabetes. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/Diab…

Coons, J. C., McGraw, M., & Murali, S. (2011). Pharmacotherapy for Acute Heart Failure Syndromes. American Journal of Health-System Pharmacy,68(1), 21-35. Retrieved from https://www.medscape.com/viewarticle/735149_8.

Kow, F. P., & Ong, H. T. (2011). Beta-blockers for heart failure: Why you should use them more. The Journal of Family Practice, 60(8), 472-477. Retrieved from https://www.mdedge.com/jfponline/article/64412/cardiology/beta-blockers-heart-failure-why-you-should-use-them-more.

Ogbru, O. (2018a). ACE Inhibitors Drug Class Side Effects, List of Names, Uses, and Dosage. Retrieved from https://www.medicinenet.com/ace_inhibitors/article…

Ogbru, O. (2018b). Furosemide. Retrieved from https://www.medicinenet.com/furosemide/article.htm…

Discussion 5

What nursing interventions are appropriate for Mrs. J. at the time of her admission? 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. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)

Given the condition that Mrs. J. is suffering from, the best interventions that are appropriate at the time of her admission would include administration of oxygen thru intubation since she has difficulty in breathing, administration of diazepam or any anxiolytic which could allow the patient to relax and finally provide an antibiotic that would help her manage the respiratory infection specified by pharyngitis.

What is the rationale for the administration of each of the following medications?

IV furosemide (Lasix)

Administration of IV furosemide (Lasix) will help decrease extravascular volume by persuading diuresis therefore reducing preload and the work of the heart in pumping blood is decreased hence prevent progression of heart failure.

Enalapril (Vasotec)

Given that Enalapril is an ACE inhibitor (angiotensin-converting enzyme inhibitor), which prevents the constriction of blood vessels. As a result, it leads to the vasodilation of peripheral vessels preventing the prevalence of heart failure.

Metoprolol (Lopressor)

Despite being used as a beta-blocker which affects the heart and circulation (blood flow through arteries and veins), metoprolol is used in the treatment of angina (chest pain) and hypertension (high blood pressure). It can be used in this case to prevent possible cases of heart attack.

IV morphine sulphate (Morphine)

This drug belongs to a class of drugs known as opioid (narcotic) analgesics whose main role is management of pain.

Describe four cardiovascular conditions that may lead to heart failure

Different cardiovascular conditions exist that may lead to heart failure, for instance,

Coronary artery disease: This mainly lead to heart failure when cholesterol and fatty deposits build up in the heart’s arteries, limiting the amount of blood reaching the heart muscle. This build-up is known as atherosclerosis. The result may be chest pain (angina) or, if blood flow becomes totally obstructed, a heart attack.

Myocardial infarction: this can occur 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, hence, leading to heart failure.

High blood pressure (hypertension or HBP): this is a major risk factor for developing heart failure. When pressure in the blood vessels is too 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; that can as a result lead to heart failure.

what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

To prevent the occurrence of heart failure monitoring the blood pressure is important to prevent abnormal blood pressure hence overworking the heart. Monitoring the blood sugar can help prevent hypertension and atherosclerosis from leading to elevated lipid levels in the blood, the monitoring can also help prevent and decrease the blood sugar levels. Also, monitoring the levels of cholesterol can help reduce chances of getting coronary artery disease that can later lead to heart failure.

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. Provide rationale for each of the interventions you recommend

The nursing interventions that could help prevent problems caused by multiple drugs interactions in older patient include;

Maintaining an accurate list and record of all drugs administered to the patient. The process is important since it can help the physicians understand the medications they administered to the patient hence preventing addition of the same medications.

Patient education. This would include giving sufficient info to the patient to keep an updated status between the physician and the patient, hence helping to guide the patient on the right drug to use and at which period.

Also, helping the patient to manage their drugs by assigning a homecare nurse can ensure that the patient completes the drugs and disposes expired medications.

References

American Heart Association (2017). Causes of Heart Failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., … & Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure14(8), 803-869.

MayoClinic (2017). Diseases and Conditions: Heart failure. Retrieved from https://www.mayoclinic.org/diseases-conditions/hea…

Discussion 6

In the event of Mrs. J it would be appropriate to say that her admission due to acute decompensated heart failure is due to her noncompliance of not taking her heart medications for 4 days and continuous smoking history. Although her diet is unknown it could also be an affect to her current condition. In congestive heart failure (CHF) there is a problem with the pumping of the heart making it difficult for the heart to pump blood to the rest of the body and causing a backup flow of fluids to your lungs and body, (Health Line, 2018). In Mrs. J’s case her heart and blood medication are to help her keep her CHF controlled and when noncompliant along with other things like poor diet and exercise, it can cause acute heart failure, a worsening of her uncontrolled CHF, where new onset symptoms can arise, (Arrigo, Parissis, Akiyama, & Mebazaa, 2016). Which in Mrs. J’s case she has developed difficulty breathing, palpitations, and exhausted.

Upon admission the appropriate interventions for Mrs. J is to first to provide her oxygen supply due to her difficulty breathing and pulse oximetry of 82%. These signs indicate that she is not receiving enough oxygen on room air, therefore administering oxygen is appropriate. Sitting her up in high fowlers is also the appropriate intervention because she is experiencing fluid buildup, in other words retaining fluid, as evidence by pulmonary crackles, and decrease breath sounds. Laying her flat can create more fluid to backup into the lungs causing greater difficulty in breathing. Appropriate medications should be administered as well as a continuation of cardiac assessment, vital signs, and monitoring is essential for any changes in condition.

Medications like furosemide (Lasix) is administered to move fluid that is build up in the lungs and body out the body through urination. Furosemide (Lasix) is a loop-diuretic that acts on the kidneys to produce urine from the fluid buildup in the body which helps the excess fluid to be removed through urination and out of the body, (Health Line, 2018). In Mrs. J’s case it will help the fluid buildup in her lungs and body to be removed and help improve her condition.

Enalipril (Vasotec) is an angiotensin-converting enzyme inhibitor (ACE inhibitor) that is used for blood pressure, and CHF. It helps the vessels to dilate so that blood can properly flow to your heart and body, therefore improving blood flow, (Health Line, 2018). In Mrs. J case Enalapril is given to help the blood flow so that the heart is able to pump more easily.

Metoprolol (Lopressor) is a beta-blocker that can reduce high blood pressure as well as rapid uncontrolled heart rate, therefore used to slow and control the heart rate to normal rate, (Health line, 2018). In Mrs. J’s case it given to control her rapid heart rate of 118 and irregularity.

Morphine is a an opioid that is used for pain, however reported to reduce preload, heart rate, and afterload and help dilate the vessels which in CHF is needed to help reduce the oxygen demand in the heart, it is also know to decrease anxiety and help relaxation for better breathing, (Coons, McGraw, Murali, 2011). In Mrs. J’s case she is having heart failure symptoms of her heart overworking causing her a rapid heart rate and difficulty breathing that is giving her anxiety. Morphine will her fell less anxious and decrease her feeling of not being able to breath.

There are many cardiovascular conditions that can lead to heart failure like hypertension, coronary artery disease, abnormal valves, and damage to the heart like cardiomyopathy or a previous heart attack.

Hypertension is known as high blood pressure. It is when the pressure in the heart is too high and has to puck harder than normal to get blood to flow causing an overwork on the heart, (American Heart Association, 2018). It is important that as a nurse the patient is educated on the importance of blood pressure control through exercise, diet, and medication compliance.

Coronary artery disease is due to high cholesterol in blood and plaque build-up in the arteries causing obstruction of blood flow which can lead to chest pain and heart attack causing heart failure, (American Heart Association, 2018). As a nurse education on a healthy diet and exercise is essential to control cholesterol. Medical interventions like cholesterol medications or if more serious cardio procedures like stenting of the heart is appropriate.

Abnormal Valves in the heart is a defect on the valves of the heart, a malfunction where they do not close or open properly causes the heart to overwork and over stress itself that eventually can result to heart failure, (American Heart Association, 2018). In this situation education about the heart valves and following up with a cardiologist is essential procedures to repair the defected heart valves.

Cardiomyopathy is an enlarged heart due to heart damage. The damage can be from drug use, birth defects, heart attack or unknown reasons, (American Heart Association, 2018). The appropriate interventions are to regularity follow up with a cardiologist, cardiac medications, and cardiac diet.

Polypharmacy is referred to the effects of too many drug administrations, (American Nurses Today, 2018). Many older adults take more than three prescription drugs due to multiple health issues, therefore medication management is very important to help prevent drug interactions, miss doses, or even drug overuse. As a nurse to help polypharmacy risk in patients from occurring it is important to discuss the medications with patients and the importance of having an up to date medication list of all prescription and over the counter medications, vitamins, herbal, doses, frequency, and reason (American Nurses Today, 2018). It is important that they keep the list updated and that they provide a copy to all care providers as well as use the same pharmacy for all prescriptions to avoid confusion. This is important to avoid duplication and drug interactions. It is important to teach the patient what each drug is for and what it does so that they have an understanding of why the drug is needed and important to take as directed. It is also important to teach them about abnormal signs when taking current or new medications, and when it is essential to report to a healthcare provider, this will help avoid any urgent or emergency situation, (American Nurses Today, 2018). For some older patients remembering to take medications and the purpose can be difficult to remember, therefore organizing daily medications by separating morning and night using a pill/medication organizer can help ,as well as teaching them the colors of each pill, (American Nurse Today, 2018). This will help avoid confusion and help remind them to take their pills daily.

References

American Heart Association. (2018). Causes of heart Failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

American Nurses Today. (2018). Preventing Polypharmacy in Older Patients. Retrieved from https://www.americannursetoday.com/preventing-poly…

Arrigo, M., Parissis, J., Akiyama, E., Mebazaa, A. (2016). Understanding acute heart failure: pathophysiology and diagnosis. European Heart Journal Supplements, Vol 18. Pg. G11-G18. Retrieved from https://academic.oup.com/eurheartjsupp/article/18/…

Coons, J., McGraw, M., Murali, Srinivas. (2011). Pharmacotherapy for Acute Heart Failure Syndromes. Retrieved from https://www.medscape.com/viewarticle/735149_8

Health Line. (2018). What are the most common types of CHF?. Retrieved from https://www.healthline.com/health/congestive-heart…

 

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