Mrs. J. is a 63-year-old married woman who has a history of hypertension
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
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 subjective and objective clinical manifestations present in Mrs. J.
- Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?
- By following the nursing process, were the interventions at the time of admissions beneficial for Mrs. J? Would you change any of the interventions to ensure patient independence and prevent readmission?
- Explain each of the seven medications listed in the scenario above. Include the classification, the action, and the rationale for each of these. 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, including maintenance of medications. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission.
- Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Rubric Criteria
Criterion | 1. Unsatisfactory | 2. Insufficient | 3. Approaching | 4. Acceptable | 5. Target |
|---|---|---|---|---|---|
Clinical Manifestations of Patient Description of subjective and objective clinical manifestations | 0 points Subjective and objective clinical manifestations are omitted. | 9 points Subjective and objective clinical manifestations are present but lack detail or are incomplete. | 9.48 points Subjective and objective clinical manifestations are present. | 10.68 points Subjective and objective clinical manifestations are detailed. | 12 points Subjective and objective clinical manifestations are thorough. |
Cardiovascular Conditions Leading to Heart Failure and Interventions Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure. Explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the presented conditions. | 0 points Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure and/or explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are omitted. | 13.5 points Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure and/or explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are present, but lack detail or are incomplete. | 14.22 points Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure, and an explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are present. | 16.02 points Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure is and an explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are detailed. | 18 points Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure, and an explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are thorough. |
Evaluation of Nursing Interventions at Admissions Description of the benefit of the intervention at the time of admission using the nursing process. Explanation of any changes to the interventions to ensure patient independence and prevent readmission. | 0 points Description of the benefit of the intervention at the time of admission using the nursing process and/or explanation of any changes to the interventions to ensure patient independence and prevent readmission are omitted. | 9 points Description of the benefit of the intervention at the time of admission using the nursing process and/or explanation of any changes to the interventions to ensure patient independence and prevent readmission are present, but lack detail or are incomplete. | 9.48 points Description of the benefit of the intervention at the time of admission using the nursing process, and an explanation of any changes to the interventions to ensure patient independence and prevent readmission are present. | 10.68 points Description of the benefit of the intervention at the time of admission using the nursing process and an explanation of any changes to the interventions to ensure patient independence and prevent readmission are detailed. | 12 points Description of the benefit of the intervention at the time of admission using the nursing process and an explanation of any changes to the interventions to ensure patient independence and prevent readmission are thorough. |
Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each. Discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions. | 0 points Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each, and/or discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are omitted. | 13.5 points Explanation of seven medications listed in the scenario, including the classification, action, and rationale for and/or discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions is present, but lacks detail or are incomplete. | 14.22 points Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each and discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are present. | 16.02 points Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each, and discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are detailed. | 18 points Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each, and discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are thorough. |
Health Promotion and Restoration Teaching Plan Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission. | 0 points Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications and/or explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are omitted. | 13.5 points Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications and/or explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are present, but lack detail or are incomplete. | 14.22 points Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications, and explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are present. | 16.02 points Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications, and explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are detailed. | 18 points Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications, and explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are thorough. |
COPD Triggers and Options for Smoking Cessation Discussion of options for smoking offered considering patient’s current and long-term tobacco use. Outline of COPD triggers that can increase exacerbation frequency, resulting in readmission. | 0 points Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use is omitted and/or outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are omitted. | 13.5 points Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use and/or outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are present, but lack detail or are incomplete. | 14.22 points Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use, and outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are present. | 16.02 points Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use, and outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are detailed. | 18 points Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use, and outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are thorough. |
Thesis, Position, or Purpose Communicates reason for writing and demonstrates awareness of audience. | 0 points The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident. | 4.5 points The thesis, position, or purpose is unfocused or confused. There is very little awareness of the intended audience. | 4.74 points The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience. | 5.34 points The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated. | 6 points The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience. |
Development, Structure, and Conclusion Advances position or purpose throughout writing; conclusion aligns to and evolves from development. | 0 points No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered. | 4.5 points Writing lacks logical progression of the thesis, position, or purpose. Some organization is attempted, but ideas are disconnected. Conclusion is unclear and not supported by the overall development of the purpose. | 4.74 points Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose. | 5.34 points The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose. | 6 points The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose. |
Evidence Selects and integrates evidence to support and advance position/purpose; considers other perspectives. | 0 points Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer. | 4.5 points Evidence is limited or irrelevant. The interpretation of other perspectives is superficial or incorrect. | 4.74 points Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present. | 5.34 points Relevant evidence that includes other perspectives is used. | 6 points Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered. |
Mechanics of Writing Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc. | 0 points Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout. | 2.7 points Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent. | 2.84 points Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted. | 3.2 points Few mechanical errors are present. Suitable language choice and sentence structure are used. | 3.6 points No mechanical errors are present. Appropriate language choice and sentence structure are used throughout. |
Format/Documentation Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline. | 0 points Appropriate format is not used. No documentation of sources is provided. | 1.8 points Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident. | 1.9 points Appropriate format and documentation are used, although there are some obvious errors. | 2.14 points Appropriate format and documentation are used with only minor errors. | 2.4 points No errors in formatting or documentation are present. |
Expert Answer and Explanation
Case Study on Cardiopulmonary Complexities
The status of one’s physiological health may change from time to time because emotions and psychological health can alter the health-illness continuum. However, an individual’s lifestyle can equally affect the status of their physiological and psychological health. Smoking of the tobacco is one of the habits which can end up harming a person’s health.
This is because it can cause a number of conditions, and alter the functioning and performance of the cardiovascular system (John & Schöllhorn, 2018). This warrants the need for the providers to intervene in a scenario where a patient with such a habit is at risk of developing the Chronic Obstructive Pulmonary Disease (COPD) as this study explores.
Clinical Manifestations
Mrs. J. exhibits certain clinical manifestations. According to the clinical details, the patient is experiencing body weakness, and this is the reason why she cannot perform activities of daily living (ADLs). Another clinical manifestation is shortness of breath. Because of her breathing issue, she needs 2Liters of oxygen during activity. The patient is also experiencing abnormal breathing, and this is why she states she feels like her heart is skipping (John & Schöllhorn, 2018).
Appropriateness of the Nursing Interventions and Rationale
Mrs. J. receives nursing interventions focused on helping restore her health. She receives a number of medications including the Enalapril and Metoprolol. This patient has congestive heart failure (CHF). Administering Enalapril can help promote the recovery from this condition. Part of the administered interventions include the use of the Lasix. This drug treats ventricular dilation. Inhaled bronchodilator is also used. The reason for the use of this medication is to open the airways for the patient. The inflammation of her lungs requires that she use corticosteroid (Ramamoorthy & Cidlowski, 2016).
Cardiovascular Conditions which Result to Heart Failure
Certain conditions can end up causing the heart failure. Untreated diabetes, for instance, can contribute to the development of this clinical problem. This is because the condition causes the blood sugar to rise to the abnormal levels, and ultimately damage the blood vessels. Hypertension is another condition that can cause the heart to fail. This is because it can increase the force of the blood, and when this force increases to an abnormal level, it can result to damage of the blood vessels. Sleep apnea and atherosclerosis can additionally cause the CHF (Inamdar & Inamdar, 2016).
Nursing Interventions to Prevent the Heart Failure in the Conditions
Nursing interventions can be effective in preventing the failure of the heart. For patients with hypertension, thiazide can help reduce the adverse effects of the disease, and eventually help limit the risk of heart failure. Provigil can also be effective in limiting the risk of heart failure. This medication treats sleep apnea, and it can therefore reduce the impact of this condition in terms of causing CHF. Treatment with insulin can further decelerate the impact of the disease (Inamdar & Inamdar, 2016).
Four Nursing Interventions against Drug Interaction and Rationale
When treating a patient with co-occurring disorders, a nurse has to pay observe the treatment protocol so that they can avoid mistakes may cause adverse drug events. Correct documentation of the prescription information, for example, can help a nurse lower the risk of adverse events to the patient. This extends to writing of the prescription information, and these details should be clear enough so that the patient can read.
Patient education can also help prevent the problem of drug interaction (Farooqui et al., 2018). Another intervention involves collaborating with the patient’s family to improve the wellbeing of the patient. When the provider involves the patient’s kin, the patient receives support necessary for adherence. The other intervention is the use of the checklist. This helps a patient take the right medication.
Health Promotion and Restoration Teaching Plan
For Mrs. J., the health promotion and restoration plan seeks to promote her physiological and emotional health, and empower her so that she can avoid high-risk behaviors. The health education for this patient will take two weeks, and the education activities will include the use of the charts to help her be aware of the dangers of smoking. The expected outcomes for this education include empowered patient who can manage her own health by making appropriate personal decisions (Ziaeian & Fonarow, 2016). The restoration and rehabilitation will be useful for this patient because it will make it possible for her to overcome her habit of smoking.
A Method for Patient Education
The method of education which Mrs. J. can benefit most from is the use of the charts. This method of education is important in the sense that it presents an easy means of learning for the patient.
COPD Triggers
When one smokes persistently, this can trigger their COPD. This is because the smoke particles block the airways, and can ultimately cause the shortness of breath.
Smoking Cessation Options
Smoking cessation options for the patient in the case study include the use of a set of medications. The nicotine replacement therapy is one of the interventions which can help attain this goal.
Conclusion
In conclusion, the behaviors a person adopts can worsen their health, and it is imperative for a nursing intervention to focus on relieving the health impact associated with certain lifestyle behaviors. The smoking, in addition to other conditions such as hypertension can eventually lead to the heart failure. This is why a nurse has to treat physiological conditions while educating the patient.
References
Farooqui, R., Hoor, T., Karim, N., & Muneer, M. (2018). Potential Drug-Drug Interactions among Patients prescriptions collected from Medicine Out-patient Setting. Pakistan journal of medical sciences, 34(1), 144–148. Doi: https://doi.org/10.12669/pjms.341.13986.
Inamdar, A. A., & Inamdar, A. C. (2016). Heart Failure: Diagnosis, Management and Utilization. Journal of clinical medicine, 5(7), 62.Doi: https://doi.org/10.3390/jcm5070062.
John, A., & Schöllhorn, W. I. (2018). Acute Effects of Instructed and Self-Created Variable Rope Skipping on EEG Brain Activity and Heart Rate Variability. Frontiers in behavioral neuroscience, 12, 311. Doi: https://doi.org/10.3389/fnbeh.2018.00311.
Ramamoorthy, S., & Cidlowski, J. A. (2016). Corticosteroids: Mechanisms of Action in Health and Disease. Rheumatic diseases clinics of North America, 42(1), 15–vii. Doi: https://doi.org/10.1016/j.rdc.2015.08.002.
Ziaeian, B., & Fonarow, G. C. (2016). Epidemiology and aetiology of heart failure. Nature reviews. Cardiology, 13(6), 368–378.Doi: https://doi.org/10.1038/nrcardio.2016.25.
Understanding Heart Failure: Causes, Symptoms, and Nursing Care
Heart failure, medically known as Congestive Heart Failure (CHF) or HF, is a physiological condition where the heart’s ability to pump blood falls short of meeting the body’s metabolic demands. This can result from either structural or functional issues related to the heart’s ventricular filling or ejection of blood.
Exploring the Causes of Heart Failure
HF primarily stems from changes in the systolic or diastolic function of the left ventricle. The heart fails when, due to intrinsic disease or structural limitations, it cannot manage a normal blood volume or sudden increases in blood volume. Notably, heart failure is often a consequence of various cardiovascular conditions such as chronic hypertension, coronary artery disease, and valvular disease.
Heart Failure: A Complex Clinical Syndrome
It’s essential to understand that heart failure itself is not a standalone disease; rather, it signifies a clinical syndrome characterized by manifestations like volume overload, inadequate tissue perfusion, and poor exercise tolerance. Regardless of the underlying cause, pump failure leads to insufficient tissue perfusion, followed by venous congestion both in the pulmonary and systemic systems.
Clinical Manifestations: Left-Sided vs. Right-Sided Heart Failure
The signs and symptoms of heart failure differ based on whether it affects the left side, right side, or both ventricles. Typically, left-sided heart failure tends to manifest first and displays distinct indicators.
Left-Sided Heart Failure Symptoms
- Dyspnea on exertion
- Pulmonary congestion with crackling sounds
- Initially dry, nonproductive cough
- Frothy sputum, sometimes tinged with blood
- Inadequate tissue perfusion
- Weak, thready pulse
- Tachycardia
- Oliguria and nocturia
- Fatigue
Right-Sided Heart Failure Symptoms
- Congestion of the viscera and peripheral tissues
- Edema in the lower extremities
- Enlargement of the liver (hepatomegaly)
- Ascites
- Anorexia and nausea
- Weakness
- Weight gain due to fluid retention
Renaming Heart Failure
Traditionally referred to as “congestive heart failure,” this nomenclature is now less commonly used by cardiac specialists. Alternative terms include chronic heart failure, cardiac decompensation, cardiac insufficiency, and ventricular failure.
The Role of Nurses in Heart Failure Care
Nurses play a pivotal role in improving outcomes for heart failure patients through education and vigilant monitoring. Despite the challenges and high morbidity and mortality rates associated with HF, nursing interventions can make a significant difference.
Prioritizing Nursing Care
For patients with congestive heart failure, nurses focus on the following priorities:
- Enhancing myocardial contractility and perfusion to ensure adequate organ blood flow through medications, vital sign monitoring, and optimizing fluid balance.
- Managing fluid volume by monitoring retention, administering diuretics, checking weight, and encouraging adherence to a low-sodium diet.
- Preventing complications by closely monitoring and managing issues like pulmonary edema, arrhythmias, and thromboembolism, coupled with patient education.
- Promoting activity tolerance by encouraging daily physical activity (as tolerated), scheduling activities, and prioritizing exercises.
- Reducing anxiety by providing psychological support and teaching anxiety management techniques.
- Minimizing feelings of powerlessness by encouraging patient input and involving them in decision-making.
- Offering disease information and prevention education, including educating patients about heart failure, its implications, lifestyle changes, medication adherence, and the importance of timely care to prevent symptom exacerbation.
Assessing Heart Failure
Nursing assessment for heart failure patients is focused on evaluating treatment efficacy and patient adherence to self-management strategies. Monitoring and promptly reporting worsening heart failure signs and symptoms are vital for adjusting therapy. Additionally, nurses address the emotional well-being of patients, as heart failure is often linked to depression and psychosocial concerns.
Key Assessment Areas
Health History
- Assess for symptoms like dyspnea, fatigue, and edema.
- Inquire about sleep disturbances, particularly those interrupted by shortness of breath.
- Gauge the patient’s comprehension of HF, self-management strategies, and their willingness to adhere to these strategies.
Physical Examination
- Listen to the lungs for crackles and wheezes.
- Auscultate the heart for the presence of an S3 heart sound.
- Examine for jugular venous distention (JVD).
- Evaluate the patient’s sensorium and level of consciousness.
- Assess dependent body parts for perfusion and edema.
- Check for hepatomegaly (enlarged liver).
- Monitor urinary output to establish a baseline for assessing diuretic therapy’s effectiveness.
- Weigh the patient daily to monitor fluid retention.
Assess for the Following Subjective and Objective Data
- Increased heart rate (tachycardia)
- ECG changes
- Blood pressure fluctuations (hypotension/hypertension)
- Extra heart sounds (S3, S4)
- Decreased urine output (oliguria)
- Diminished peripheral pulses
- Orthopnea
- Crackles
- Jugular vein distention
- Edema
- Chest pain
- Weakness
- Fatigue
- Changes in vital signs
- Presence of dysrhythmias
- Dyspnea
- Pallor
- Diaphoresis
- Weight gain
- Respiratory distress
- Abnormal breath sounds
Assess for Factors Related to the Cause of Congestive Heart Failure
- Altered circulation
- Changes in myocardial contractility and inotropic status
- Alterations in heart rate, rhythm, and electrical conduction
- Decreased cardiac output
- Structural changes (e.g., valvular defects, ventricular aneurysm)
- Poor cardiac reserve
- Medication side effects
- Imbalance between oxygen supply and demand
- Prolonged bed rest
- Immobility
- Reduced glomerular filtration rate due to decreased cardiac output and increased antidiuretic hormone (ADH) production, along with sodium/water retention.
- Changes in glomerular filtration rate
- Use of diuretics
- Lack of understanding
- Misconceptions about the interrelatedness of cardiac function, disease, and failure
- Invasive procedures
- Extended hospitalization
- Alveolar edema resulting from increased ventricular pressure
- Retained secretions
- Increased metabolic rate due to pneumonia
Formulating Nursing Diagnoses
After a thorough assessment, nurses create specific nursing diagnoses tailored to the challenges posed by heart failure. These diagnoses help structure patient care, though their application may vary depending on the clinical situation. In real-world clinical settings, nurses rely on their clinical expertise and judgment to craft care plans that address each patient’s unique needs and priorities, prioritizing their health concerns.
Crafting Nursing Care Plans for Heart Failure Patients
Following a comprehensive patient assessment, nursing diagnoses are meticulously formulated to tackle the challenges posed by heart failure. These diagnoses serve as a vital framework for organizing care, though their specific utility may vary across different clinical situations. In real-world healthcare settings, the utilization of precise nursing diagnostic labels may not always be as prominent as other aspects of patient care. Ultimately, it is the nurse’s clinical expertise and judgment that will shape a care plan tailored to meet the unique needs, health concerns, and priorities of each patient.
Nursing Goals and Expected Outcomes
When caring for patients with heart failure, the primary objectives encompass promoting physical activity, reducing fatigue, alleviating symptoms of fluid overload, managing anxiety, empowering patients in decision-making, and providing comprehensive health education to both the patient and their family. These goals and expected outcomes can be summarized as follows:
- The patient will demonstrate optimal cardiac output, as evidenced by vital signs within acceptable ranges, absence or control of dysrhythmias, and freedom from heart failure symptoms.
- The patient will actively engage in activities that reduce the workload on the heart.
- The patient will participate in desired activities and attend to their own self-care needs.
- The patient will maintain stable fluid volume, characterized by balanced intake and output, clear or improving breath sounds, vital signs within acceptable range, stable weight, and the absence of edema.
- The patient will express an understanding of their individual dietary and fluid restrictions.
- The patient will prioritize the maintenance of skin integrity.
- The patient will effectively manage pain.
- The patient will identify strategies to mitigate anxiety.
- The patient will demonstrate improved concentration.
- The patient will actively partake in their treatment regimen based on their capabilities and circumstances.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions designed for patients grappling with congestive heart failure encompass a comprehensive spectrum of care. These interventions include:
- Initiating Interventions for Decrease in Cardiac Output: Implementing measures to enhance cardiac output through medications, vital sign monitoring, and fluid balance optimization.
- Monitoring Diagnostic Procedures and Laboratory Studies: Vigilant monitoring of diagnostic tests to assess heart function and overall health.
- Administering Medication and Providing Pharmacological Interventions: Administering medications as prescribed by healthcare providers to manage heart failure symptoms.
- Maintaining or Improving Respiratory Function: Ensuring patients receive the necessary oxygen support and respiratory care.
- Managing Fluid Volume and Electrolyte Imbalance: Monitoring and regulating fluid balance to prevent complications related to fluid overload.
- Providing Perioperative Nursing Care: Offering care before, during, and after surgical procedures related to heart failure management.
- Managing Acute Pain and Discomfort: Alleviating pain and discomfort through appropriate interventions and medications.
- Promoting Adequate Tissue Perfusion and Managing Decreased Cardiac Tissue Perfusion: Implementing strategies to ensure tissues receive sufficient blood flow.
- Promoting Optimal Nutritional Balance and Adherence to Low-Sodium Diet: Educating patients about dietary restrictions and providing guidance for a heart-healthy diet.
- Maintaining Skin Integrity & Preventing Pressure Ulcers: Preventing skin breakdown and pressure ulcers through attentive care and turning schedules.
- Managing Decreased Tolerance to Activity and Fatigue: Encouraging physical activity tailored to the patient’s capabilities and addressing fatigue.
- Reducing Anxiety, Fear, and Improving Coping: Offering psychological support, teaching coping techniques, and addressing emotional well-being.
- Initiating Health Teaching and Patient Education: Educating patients and their families about heart failure, its management, lifestyle modifications, and the importance of timely care.
