Nursing Interventions and Rationale for Medications Paper
Heart failure is a severe and advancing condition in which the heart muscles cannot pump sufficient quantities of blood enough that the body’s requirements are fulfilled with the necessary oxygen supply (Farmakis et al, 2015). Mrs. J. has been admitted to the ICU for acute decompensated heart failure (ADHF). Considering that she was not feeling well, sick from influenza, and was not taking her medicine, all these might be the source of her illness. Symptoms of COPD in this situation are seen in recurrent respiratory problems that Mrs. J experiences, anxiety disorder, tachycardia, chronic cough, breathing difficulties, decreased strength, and chest tightness.
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Nursing Interventions and Rationale for Medications
According to Farmakis et al. (2015) enalapril is an inhibitor medicine that limits angiotensin to enable the relaxation of blood vessels. Relaxation of blood vessels enables the heart to not function too much-pumping blood around the body. This leads to a reduction in symptoms such as fatigue, swelling, and shortness of breath. This medication poses adverse effects such as reduced coughing capability, metallic taste in the mouth, lightheadedness, and dizziness (WebMD, 2017). Furosemide medicine causes the removal of excess water by the kidneys through increased urination (Canaan, 2017). The overload of the body and the lungs with fluids can result in swelling and breathing problems. By Mrs. J taking this medicine, it will eliminate the excess fluids that have been developed thus resulting in breathing and coughing improvements (American Heart Association, 2017). Additionally, the patient takes metoprolol, which is a beta-blocker that inhibits the receptors present in the heart. The drug has a positive impact on her tension levels and reduces her heart rate so that she does not become overwhelmed. Morphine sulfate is the final medicine the patient takes. This medication has been confirmed to lower the heart rate. However, this medication needs to be taken with caution as it can also lower blood pressure (Farmakis et al., 2015).
Cardiovascular Conditions and Heart Failure
Coronary Artery Disease (CAD) is one of the most severe heart failure diseases (Farmakis et al., 2015). Certain preventive measures should be considered. Patients should be advised and motivated to engage in activities that will enable them to avoid smoking. Diet adjustments and involvement in more active programs suitable to her age are also suggested. Hypertension necessitates regular assessment and medicine combination will assist in managing blood pressure. Furthermore, lifestyle adjustments would also be promoted to improve her health. Congenital cardiac abnormalities can also result in heart failure (Farmakis et al., 2015). Regarding the prevention approach, the diagnosis must indicate setbacks and effective management of arrhythmias, as well as medicine that may potentially deter infections. Heart failure can also be caused by damaged muscles of the heart. The reason behind this is that impaired muscles cannot function properly, thus weakening the capability of the heart to pump blood.
Prevention of Issues with Multiple Drug Interactions
Recording a list of drugs a patient is taking is critical to avoid problems due to multiple drug interactions. Keeping drugs in a proper and secure location and checking the expiry dates are essential. The reason is that the chemicals found in medications are sensitive and when subjected to hot or humid conditions, it may affect the impact of the drugs (Farmakis et al., 2015). It is, therefore, necessary to educate patients on the correct use of medicines while reminding them not to refrain from taking any medications before talking to their physician beforehand. It may significantly minimize withdrawal effects and improve the effectiveness of drugs she continues to take. Adverse effects, negative outcomes, and more can always be addressed in such a manner that the patient is conscious of what may arise while beginning a new medication or using multiple drugs.
Health Promotion and Restoration Plan
In establishing Mrs. J’s recovery plan, she will have to adhere to all medicines administered during her appointment to guarantee adherence to appropriate monitoring. She has to stop smoking and consider other approaches. She can also have a dietary adjustment to eat healthier meals and increase her consumption of fruits and vegetables. Handling anxiety and depression may be helpful, thus the patient needs to participate in counseling programs.
Preventing Future Hospital Admissions
The significant move is to educate Mrs. J from admission on the importance of adhering to all measures and advice provided to her to ensure a good outcome for her problem. In determining her understanding of the medications she is taking, I would ask her to describe the use of each medication. It will help pinpoint her understanding and address any incorrect information she might have established to appropriate utilization of her drugs. Moreover, Discussing her problem and symptoms in a basic manner will enable her to grasp the severity of the effects if she fails to take the correct actions and advice as recommended. The involvement of her care provider and family will ensure that guidelines and suggestions are correctly implemented so that she is more motivated to avoid unhealthful activities to improve her health results.
COPD Triggers and Smoking Cessation
If Mrs. J does not comply with the strategy laid out for her after being discharged from the medical facility by failing to take the proper dose of prescription drugs and following the smoking cessation plan, it may lead to future readmissions. Exposures to adverse weather conditions, air pollution, or mold, could also interrupt the program that she tries to use to relieve her symptoms. To facilitate a cessation of smoking, she will be advised to utilize a nicotine substitute that may involve gum, patches, or inhalers.
References
American Heart Association (2017). Medications used to treat heart failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFailure/TreatmentOptionsForHeartFailure/Medications-Used-to-Treat-Heart-Failure_UCM_306342_Article.jsp#.WzqutWaZPOQ.
Canaan K. (2017). Effects of Lasix on Congestive Heart Failure. Retrieved from http://www.livingstrong.com/article/154157-effects-of-lasix-on-congestive-heart-failure/
Farmakis, D., Parissis, J., Lekakis, J., & Filippatos, G. (2015). Acute heart failure: epidemiology, risk factors, and prevention. Revista Española de Cardiología (English Edition), 68(3), 245-248.
WebMD (2017). Heart Failure Health Center. Retrieved from https://www.webmd.com/heart-disease/heart-failure/default.htm
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
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Health History
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is “running away.”
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
Describe the clinical manifestations present in Mrs. J.
Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
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.
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 a rationale for each of the interventions you recommend.
Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
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