1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family.
2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology.
a. This can be done in the form of a table – each point needs to be appropriately referenced
3. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body.
a. This does not mean specific drugs but rather the class that these drugs belong to.
4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient.
Mrs Sharon McKenzie is a 77 year old female who has presented to the emergency department with increasing shortness of breath, swollen ankles, mild nausea and dizziness. She has a past history of MI at age 65. During your assessment Mrs McKenzie reports the shortness of breath has been ongoing for the last 7 days, and worsens when she does her gardening and goes for a walk with her husband. Nursing Care Strategies For Congestive Heart Failure Patient Essay Paper
On examination her blood pressure was 170/110 mmHg, HR 54 bpm, respiratory rate of 30 bpm with inspiratory crackles at both lung bases, and Sp02 at 92% on RA. Her fingers are cool to touch with a capillary refill of 1-2 seconds. Mrs McKenzie states that this is normal and she always has to wear bed socks as Mr McKenzie complains about her cold feet.
Her current medications include: digoxin 250mcg daily, frusemide 40mg BD, enalapril 5mg daily, warfarin 4mg daily but she sometimes forgets to take all of her medications.
The following blood tests were ordered: a full blood count (FBC), urea electrolytes and creatinine (UEC), liver function tests (LFT), digoxin test, CK and Troponin. Her potassium level is 2.5mmol/L.
Mrs McKenzie also has an ECG which showed sinus bradycardia, and a chest x-ray showing cardiac enlargement and lower-lobe infiltrates.
Impression: Congestive cardiac failure
One of the most commonly known cause of congestive heart failure or CHF is impair in the pumping capability of heart (Schultz et al., 2013). High blood pressure or hypertension also contributes to the incident of CHF. In this case the patient’s report has indicated high blood pressure that may be responsible for the CHF in the patient (Suman-Horduna et al., 2013). Coronary artery disease and poor valve condition could lead to the consequence of CHF, because in such cases the blood flow to the heart is restricted, thus it becomes difficult for the heart to pump blood effectively (Verbrugge et al., 2013). In case of Mrs Sharon, she had a history of myocardial infraction which mainly caused due to arteriosclerosis along with narrow coronary arteries. Thus, it can be said that, such condition has led to the incident of CHF in this case. In addition, diabetes, thyroid disorder, allergy and obesity are other contributing factors in the development of CHF (Schultz et al., 2013). However, in this case there was no indication of such complications. Low potassium level leads to the heart disorder. As the report of the patient has indicate low potassium level it can be said that it is another cause of CHF within the patient (Verbrugge et al., 2013).
High blood pressure, diabetes, coronary artery disease and valvular heart disease are some potential risk factors of CHF. In some cases viral infection may lead to CHF (Suman-Horduna et al., 2013). Some medications such as nonsteroidal anti-inflammatory drugs, drugs for anesthetia and anti-arrythmic drugs and some over the counter medication could lead to the event of CHF (Ouwerkerk, Voors & Zwinderman, 2014). In addition, substance abuse and lack of physical activities are also considered as the risk factors of CHF. Furthermore, the risk of CHF is higher for the older adults and obese people (Ouwerkerk, Voors & Zwinderman, 2014). In Australia the incidence of heart failure ranges between 1.0 to 2.0%. The illness impact on the patient and their family in an effective manner (Sahle et al., 2016). It could lead to long period of incapacity. It is not only the incident of biographical disruption but also disruption of lifestyle of individual suffering from the disease and their family as well. It becomes difficult for the patient and family member to cope up with functional limitations. The illness affects the socio-economic status due to the expenditure. Such complications impact the psychological health of the patient as well (Schultz et al., 2013).
It is important to observe the vital signs of the patient such as pain, BP, heart rate, respiratory rate, breathing and verbal and non-verbal cues such as moaning, restlessness, clutching of chest and diaphoresis. It would help to understand the current health condition of the patient and introduce effective interventions in order to address the health issues in an effective manner. In this case difference behaviour due to pain may create difficulties in the vital sign assessment (Feltner et al., 2014). Next the nurse should obtain the detail description of pain regarding the location, duration, intensity and characteristics of pain. It would help to introduce effective pain relief interventions in order to reduce the pain in an effective manner (Wakefield et al., 2013). The nurses need to monitor the vital sign and pain of the patient in every 30 minutes and inform the patient about reporting the nurse regarding the increase in chest pain and discomfort (Mebazaa et al., 2015). The nurses need to administer 0.4 mg Nitroglycerin Sublingual in every 5 minutes in order to relief the chest pain, because increase in pain may lead to shock due to stimulating sympathetic nervous system (Ponikowski et al., 2016). The vital signs need to be monitored before and after providing narcotic medications. This is because, severe respiratory depression and hypotension may occur due to the narcotic administration. Such conditions may lead to the increase in the myocardial damage. If the narcotic such as nitroglycerin fails to relief the pain, it is important to provide intravenous morphine in order to relief the pain (Wakefield et al., 2013).
The nurses should provide comfortable environment. Calm activities and should approach the patient with patience and calm. It would help to reduce the external stimuli that may create cardiac strain and anxiety, thus could limit the ability to cope up with illness (Feltner et al., 2014). It is important to administer adequate supplemental oxygen via face mask or nasal cannula according to the comfort of the patient as shortness in breathing has been reported. It would help to increase the amount of oxygen for the uptake of myocardia and could help to reduce the level of discomfort in an effective manner (Ponikowski et al., 2016). It is important to review the history of previous case of myocardial infraction. It would help to understand the potential risk factors and cause of illness (Mebazaa et al., 2015). In addition effective medication could be used such as Antianginals containing nitrates, because it would help to increase the coronary blood flow and perfusion (Wakefield et al., 2013). Such nursing care strategies could help to control the effect of congestive heart failure and improve the health condition of the patient in an effective manner.
References:
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Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., … & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975. Nursing Care Strategies For Congestive Heart Failure Patient Essay Paper