Ms. J’s condition of chronic heart failure presents several challenges that require careful and comprehensive nursing interventions. The vital signs reveal atrial fibrillation, tachypnea, and hypotension, indicating the severity of her condition. The first step in her treatment is to provide supplemental oxygen to address the low oxygen saturation level of 82%. This will improve her respiratory status and oxygenation.
To monitor for cardiac arrhythmias, it is essential to place her on telemetry, which will continuously monitor her heart rhythm. Additionally, continuous oxygen monitoring will allow for close observation of her oxygen levels. Vital signs should be checked every 15 minutes to monitor her condition, including heart rate, blood pressure, respiratory rate, and temperature.
Since Ms. J is at risk for fluid overload, it is crucial to closely monitor her intake and output every 4 hours. This will provide valuable information about her fluid balance and guide decisions regarding further diuretic therapy. The head of her bed should be elevated to help alleviate any respiratory distress caused by increased fluid in the lungs.
The establishment of an intravenous (IV) line is necessary to administer medications and fluids. IV fluids will be administered to maintain a patent vein and ensure hydration. It is important to note that IV medication administration requires careful monitoring of its effects on electrolyte levels, particularly sodium, potassium, and chloride. Hypotension is a risk, so ongoing observation of blood pressure is necessary.
In terms of medication, Lasix, a diuretic, is important for removing excess fluid from Ms. J’s body. By blocking the absorption of sodium, chloride, and water, Lasix promotes diuresis and relieves fluid overload. It is usually given intravenously and has a rapid onset of action, but its effects only last for about 2 hours. Close medical supervision is crucial to monitor electrolyte levels and prevent complications such as hypotension.
An angiotensin-converting enzyme (ACE) inhibitor is another crucial medication for Ms. J’s treatment. It helps lower blood pressure and increases oxygen supply to the heart by relaxing blood vessels, reducing the workload on the heart. However, it is essential to monitor her blood pressure closely as the medication may cause a significant drop and potentially worsen her condition.
Metoprolol, a beta-blocker, is administered to slow down the heart rate and allow more time for the heart to fill with blood, ultimately improving cardiac output. This medication helps the heart pump more blood to the body. As with other medications, careful monitoring of blood pressure is necessary to prevent complications such as hypotension.
Morphine is administered to alleviate distressing symptoms such as “air hunger” and to provide pain relief. It produces a calming effect, vasodilation, and respiratory relaxation. Morphine is essential for Ms. J’s comfort and should be administered with caution, as it may cause a drop in blood pressure and respiratory depression.
It is important to note that there are various cardiovascular conditions that can lead to heart failure. Hypertension, atrial fibrillation, coronary artery disease (CAD), and some viral infections are common underlying causes. Hypertension can be managed by addressing potential triggers such as stress, caffeine, smoking, drinking, and sleep apnea. Antihypertensive medication may also be required. Atrial fibrillation can be caused by caffeine, smoking, and alcohol, so abstaining from these substances is crucial for her survival. CAD, characterized by plaque buildup in the arteries, is the most common cause of heart failure. Lifestyle modifications, such as a healthy diet with a focus on fruits and vegetables, limited red meat consumption, and cholesterol-lowering medication, can help manage CAD and prevent heart failure.
To avoid problems related to multiple drug interactions, nursing interventions such as monitoring for adverse effects and drug-drug interactions, providing education to the patient regarding medication administration and potential side effects, and involving the pharmacist for medication reviews are essential.