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One of the first things we learn in nursing school are the ABCs. Airway, Breathing, and Circulation. Mrs. J. has decreased breath sounds, a respiratory rate of 34, and O2 saturation of 82%. Mrs. J. needs immediate oxygen supplementation. She will need continuous monitoring when it comes to her vital signs and since she has an increased pulse and abnormal heart rhythm, she also will benefit from telemetry monitoring. Mrs. J. should have IV access and her urine output should be strictly monitored. This should be done by a foley catheter with a urometer due to the fluid overload she is experiencing and the Lasix medication she will be having. Daily weights must also be contained due to the rapid weight gain that happens with fluid retention with congestive heart failure. Doctor orders should be reviewed carefully and medications administered as ordered.
IV furosemide, or Lasix, is used to assist with excreting extra fluids out of the body. Mrs. J. has edema and crackles in her lungs which indicates fluid overload. Lasix will help her to urinate any excess fluids. Enalapril, or Vasotec, is an ACE inhibitor. “ It works by blocking a substance in the body that causes the blood vessels to tighten” (Mayo Clinic,2017). This will result in relaxation of the vessels which will put less work on the heart and increases cardiac output.
Metoprolol, or Lopressor is a medication typically used to lower blood pressure in those with hypertension. “When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart” (Mayo Clinic, 2017). This will also allow the heart to not work as hard and therefore will help lower Mrs. J.’s heart rate.
IV morphine sulfate can be used to help with anxiety and decrease respiratory effort. This will allow Mrs. J. to not work as hard to breath and bring her respiratory rate down from 34 breaths per minute.
Coronary heart disease is when “When cholesterol and fatty deposits build up in the heart’s arteries, less blood can reach the heart muscle” (American Heart Association, 2017). This can lead to heart failure if it is not managed appropriately. Hypertension is a big risk for developing congestive heart failure. When the vessels are constricted, the heart must work harder to perfuse the body and can eventually lead to weakening of the valves. Severe and chronic lung disease can contribute to congestive heart failure because the heart will have to work harder at supplying oxygen to the body. Obesity can also lead to congestive heart failure due to other comorbidities that may come with being obese. High cholesterol, hypertension, sleep apnea, all put pressure on the heart to work harder in the body.
Educating patients on healthy lifestyles can help lower the risk of congestive heart failure. Having a diet high in fruits and vegetables, low in fat, and low in salt may lead to a decreased incidence of high blood pressure, obesity, and high cholesterol. It is also important to educate on daily exercise. This could be as simple as walking for 30 minutes per day. It is also very important to educate on medications and the importance of being compliant with those medications. With patients being on more medications these days, it can be advised for patients to keep a current list of what they take, how often, and how much with them at all times. Having a medication list in their purse or wallet will help healthcare providers to be on the same page with the patient. It is also important to be aware of how many pharmacies these patients are using. If patients can get their medications at one pharmacy, it will help reduce the risk of medication interactions or multiple prescriptions. These medications will not only be checked by their PCPs, but the pharmacist may also catch on to a medication interaction that could occur and also send out reminder calls when a medication needs to be refilled. If patients are unsure of what all medications they take, it can also be educated that they bring all of their current medications with them to their appointments.
American Heart Association. (2017). Causes and Risks for Heart Failure. Retrieved March 11,
Heart failure. (2017). Retrieved from https://www.mayoclinic.org/diseases-conditions/hea…