What nursing interventions are appropriate for Mrs. J. at the time of her admission?
-Elevate head of bed
-ECG & other diagnostic studies
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) is a diuretic used in heart failure patients because heart failure leads to renal retention of sodium and water, which will increase the blood volume and venous pressure, and cause edema formation. Pulmonary edema (caused during left ventricular failure) can be life threatening due to pulmonary oxygen exchange being compromised. Diuretics are used to promote renal loss of sodium and water which reduces chances of vascular congestion and edema.
2. Enalapril (Vasotec) is an angiotensin-converting enzyme (ACE inhibitor). It is used to help block the angiotensin-converting enzyme, which is what is used by the body to cause the blood vessels to constrict. When you block this enzyme the blood vessels relax which cause a lower blood pressure, that increases the efficiency of the heart. This is used to help the body pump more blood out to the rest of the body.
3. Metoprolol (Lopressor) is a beta-blocker. Beta-blockers are used to help treat left ventricular systolic dysfunction. They are typically used with other medications to treat heart failure. They are also used to treat diastolic heart failure. They do this by slowing the heart rate and allowing more time for the heart to fill with blood to increase the ejection fraction.
4. IV morphine sulphate (Morphine) is used to reduce preload, heart rate, and possibly afterload, the net effect of which is a reduction in myocardial oxygen demand.
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.
-Coronary artery disease- over time arteries build up with fatty deposits. This causes reduced blood flow to the heart. This can cause a heart attack if the arteries rupture. Then blood clots can formed and may block flow to the heart’s muscle, weakening the heart’s ability to pump.
Interventions: medications like ACE inhibitors, beta-blockers, NGT, calcium-channel blockers and aspirin can be used to treat CAD and prevent heart failure. Also cardiac catheters and surgery can be done to help remove the fatty deposit build up.
-Hypertension- When your blood pressure is high your heart has to work harder to pump the blood throughout the body, over time this can cause the muscle to become thicker and the muscle will eventually become weak and not pump effectively.
Interventions: depending on the stage of hypertension the patient can treat with lifestyle changes (exercise, diet), ACE inhibitor, calcium channel blocker, or angiotensin receptor blockers.
–Arrhythmias- These can cause the heart to beat too fast which causes extra work for the heart and can cause weakness in the muscle. When the heart rate is slow it can cause the heart to no pump enough blood out of the body and can cause heart failure.
Interventions: medications, medical procedures, and surgery are options for treatment of arrhythmias. Beta-blockers, digoxin, calcium channel blockers, warfarin, heparin, aspirin, and amiodarone are some medications that can be used. Pacemakers, cardioversion, and defibrillation are some procedures that can be done to correct arrhythmias. Surgical repair of the heart valve can be done if necessary.
-Myocarditis- inflammation of the heart muscle, this can lead to left-sided heart failure.
Interventions: Medications and surgical interventions can be done to help reduce the risk of heart failure. Some medications that can be used include ACE inhibitors, beta-blockers and aldosterone receptor antagonists. In some cases immunosuppressants or immunoadsorption therapies are used. Defibrillators, intra-aortic balloon pumps, transplants, and left ventricular assistive devices can also be used.
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.
-Prevention of Polypharmacy: many older patients (and young ones as well) use multiple pharmacies to get the cheaper medications depending on the place. This can cause issues with management of drug interactions since all the pharmacies are not aware of the multiple medications you are taking to know if there are possible interactions.
-Compile a list of medications so all physicians can see what the patient is on: This can be helpful when seeing multiple doctors for different symptoms. If you bring a list of the medications you are currently on and keep it updated it can prevent the physician from prescribing medications that can not go together or over medication.
-Monitor for absorption rate changes: As patients get older the body does not work the same, making sure the body is absorbing the medications as it is supposed to would be important to prevent patient from becoming toxic from too much of a certain medication due to the delay in absorption.
-Dietary monitoring: Many medications need to be taken with specific dietary restrictions, such as warfarin. These medications should not be taken with additional OTC medication or herbal remedies without physician approval. If taken the wrong way could be highly dangerous for the patient.