case study, heart failure

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Health Medical

Description

Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

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 so exhausted she cannot eat or drink by herself.

Objective Data

Height 175 cm; Weight 95.5 kg

Vital signs: T 37.6 C, 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 4 cm below costal margin

Critical Thinking Questions

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?

IV furosemide (Lasix)

Enalapril (Vasotec)

Metoprolol (Lopressor)

IV morphine sulphate (Morphine)

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.

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.

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Explanation & Answer

Attached.

Running head: CRITICAL THINKING QUESTIONS

Critical Thinking Questions

Institutional Affiliation

Date

1

CRITICAL THINKING QUESTIONS

2

The Appropriate Nursing Interventions for Mrs. J. At The Time of Her Admission

At the time when Mrs. J. is admitted, the appropriate nursing intervention would include
measuring and monitoring her blood pressure and observing the temperature, capillary refill time
and skin color. The nurses should also measure the rate of her input and discharge and ambulate
with all means to reduce fatigue in the patient. Providing a quiet environment and convenient
would also be essential, as well as, monitoring electrolytes and maintaining fluids according to
the level required. The nursing interventions should also include regularly monitoring the vital
signs including changes in her body temperature and blood pressure. The nurses should also note
the changes in confusion, anxiety, depression, and also disorientation and provide a bed rest.

Rationale for Administration of IV Furosemide (Lasix)

She should be administered 20-80 mg daily initially as a single dose which may be
repeated after 6-8 hours while raising the dosage by between 20-40 mg until the response desired
is achieved. Maintenance doses may also be given at least once or twice per day whereby if it is
administered twice daily, the last dosage should be given earlier than 5 p.m. in order to reduce
disruption of sleep (Gahart & Nazareno, 2014). When administering Lasix, IV route is highly
recommended over IM route and may be given with milk or food to reduce gastric irritation. The
tablet may be also be crashed for Mrs. J. to swallow conveniently.

Rationale for Administration of Enal...


Anonymous
This is great! Exactly what I wanted.

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