What nursing interventions are appropriate for Mrs. J. at the time of her admission?
Elevate head of bed to patient’s comfort
Suction as needed
Monitor vital signs
Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?
- IV furosemide (Lasix): Diuretics reduce intravascular volume, leading to a decrease in central venous pressure, right and left heart filling pressures, and pulmonary vascular pressures. Venous capacitance increases, and intrapulmonary fluid returns to the circulation (Medscape, 2017).
- Enalapril (Vasotec): ACE Inhibitor, decreases the formation of the angiotensin II by blocking the enzyme that converts angiotensin I to angiotensin II, which is a vasoconstrictor. Venodilation benefits heart failure patients by decreasing venous return.
- Metoprolol (Lopressor): Beta Blocker, that selectively block B1. Reduces heart rate, contractility & AV node conduction, suppresses adrenergically induced renin secretion.
- IV morphine sulphate (Morphine): Analgesic, reduces SVR and increases venous capacity in the emergency treatment of ischemic chest pain and pulmonary edema. Also reduces myocardial O2 demand.
Need to keep in mind that the patient’s blood pressure is 90/58 and all the above medications can cause hypotension.
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.
Four conditions that present in Mrs. J’s case is obesity 95.5 kg = 210lbs, smoking, hypertension and irregular heart rate. From a nursing standpoint it is important to educate the patient on the importance of maintaining a healthy lifestyle diet and exercise, smoking cessation and medication compliance. On admission we will address her emergent health presentations and start the social work/case management referral to find out how we can assist the patient to continue on her road to recovery.
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.
Help teach the patient about the medications that have been prescribed. Keep it as simple as possible. Organize the medication in an order that can be easily followed. Keeping a list of all the medications along with the name of the providers and pharmacy number available. Most importantly to take the list of all current medications with them to their appointments (American Nurse Today, 2017).
American Nurse Today. (2017). Preventing polypharmacy in older adults. Retrieved from: https://www.americannursetoday.com/preventing-polypharmacy-in-older-adults/
Medscape. (2017). Retrieved from: http://emedicine.medscape.com/article/2145340-overview