topic 3 dq 6

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Please respond with a paragraph to the following post, add citations and references:

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

At presentation to the unit, the patient would be placed on a non-rebreather at 15L pending MD and RT evaluation. The patient would be sat up in High-fowlers position to allow for better ventilation. EKG would be taken for establishing baseline cardiac rhythm. Intravenous access would be established to allow for administration of IV medications. Initial labs would be drawn to include a CBC, CMP, BNP, troponin, and ABG. X-ray of the chest would be ordered as well.

  1. IV furosemide (Lasix)
    1. A loop diuretic that works on the ascending loop of Henle, this medication is used to decrease preload and decrease the amount of fluid in circulation which will decrease the pulmonary edema and allow for a more thorough contraction from the left ventricle.
  2. Enalapril (Vasotec)
    1. This is an ACE inhibitor which prevents the conversion of angiotensin 1 to angiotensin 2 which leads to decreased afterload, improved stroke volume, increased cardiac output, and a slight reduction in preload. This patient has uncompensated CHF and this medication will increase the left ventricle efficiency.
    2. Metoprolol (Lopressor)
      1. This is a beta-blocker aimed at blocking the effects of catecholamines in the body that can assist in controlling the AFIB the patient is experiencing and regulate the ventricular contraction rate. If the left ventricle is slowed down and allowed to fill more completely, cardiac output is increased and vascular resistance is lessened.
      2. IV morphine sulphate (Morphine)
        1. An opioid analgesic has the ability to decrease pain and have respiratory depressive functions as well. This medication is administered, carefully due to low pressure the patient is experiencing, to reduce respiratory drive, distress, and again reduce preload. The patient is anxious and breathing quickly so if we can get her to slow down, her anxiety and PaCO2 will improve as well.

          2. 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 (CAD) – a build up of cholesterol and fatty deposits build on the inside of the vessels that “feed” the heart. This stenosis causes decreased blood flow, loss of flexibility, and provides a risk of embolus a piece of the deposit breaks off. This often leads to chest pain, MI, and HTN.
            • To reduce the risk of CAD, recommendations include:
              • Stop smoking, manage cholesterol levels, exercising, and maintaining a healthy weight
            • Hypertension (HTN) – is a consistently abnormal systolic and diastolic blood pressure greater than 130 over 80. Stages of hypertension exist in four levels with one being elevated, hypertension 1, hypertension 2, and hypertensive crisis. This disease process leads to the heart having to pump harder to overcome vascular resistance. This also leads to decreased blood flow the myocardium as these vessels fill in diastole or when the ventricles are not contracting.
              • Decreasing stress, increasing exercise, maintaining a healthy weight, avoiding stimulants, avoiding drugs including cocaine and amphetamines, stop smoking, and taking medication to control blood pressure
              • Myocardial infarction – also known as a heart attack is a portion of the heart muscle being damaged or dying and scarring due to a sudden decrease of blood flow to the affected area. Many times this is due to an embolus or blood clot traveling to the heart (often from a piece of plaque) and preventing blood flow to the affected area. If the demands of the muscle are greater than the vessel is able to provide due to the clot, ischemia results and ultimately cardiac muscle damage. This damaged muscle cannot pump effectively and can lead to heart failure.
                • Decreasing the risk can include being female, exercising, quit smoking, managing cholesterol levels with an increase in high-density lipids, controlling your blood pressure, maintaining a healthy weight,
                • Dilated Cardiomyopathy (DCM) – This is the stretching and thinning of the heart chambers (ventricles and atrium) which initially affects the left ventricle. As the muscle dilates and lumen enlarges, the heart has to work harder to contract and is unable to empty completely. This progresses and ultimately leads to a lower ejection fraction and decreased cardiac output.
                  • Exercise, treating infection that can affect the heart quickly like strep, decreasing alcohol intake, avoiding the use of stimulants, illicit drugs that stimulate the heart (cocaine and amphetamines),controlling co-morbidities including hypertension.

                    • 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.

                      • Use pill sorting containers
                      • Pill sorting containers will help the geriatric patient take their medications when indicated. Some medications need to be taken separately, at different times, or even with meals.
                      • Keep an updated list of all medication with strengths and dosages to take to all physicians
                        • Physicians deal with a large patient load and primary care providers are not able to address all health issues in their office. Many times patients have multiple physicians and specialists that provide their care with each prescribing their own medication regimen. If the patient has their updated medication list available, the physicians can be aware and help prevent interactions between medications.
                      • Request large font labels on prescriptions or have the pharmacist confirm instructions
                        • Many times, patients do not intentionally take their medication wrong. Often, a patient misunderstands what they are supposed to take and when. This is also true when a physician changes a medication and tells the patient to take it differently without rewriting the prescription.
                        • Take as prescribed, not based on convenience
                          • As patient’s are busier and busier it is inconvenient to take a medication four, five, or six times per day. This is truer when attending a special event or traveling out of town when the medication has to be sorted out and accounted for. Patients find it easier to take a handful of medication twice per day rather than a few here and there as prescribed not knowing that their efficacy could be in question.

                            • References

                            Cardiogenic pulmonary edema. (2017). Retrieved from https://emedicine.medscape.com/article/157452-over…

                            Dilated Cardiomyopathy (DCM). (2016). Retrieved from https://www.heart.org/en/health-topics/cardiomyopa…