Use the following Case Scenario
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 the start of her admission, Mrs. J is going through many complications throughout most of her systems. I would follow the rules of ABC and control her respiratory problem first. Mrs. J has an oxygen saturation of 82% and is probably going to continue dropping. She will require oxygen first, possibly a nonrebreather mask. The symptoms she is facing is of a person going through acute heart failure which includes shortness of breath, coughing/wheezing, weight gain, swollen ankles, rapid heart rate, tiredness/fatigue, and loss of appetite. With Mrs. J’s signs and symptoms, she must be hospitalized immediately. She requires inpatient monitoring. Telemetry monitoring should be initiated and continued for 24-48 hours after admission. She requires a combination of diuretics, vasodilators, and inotropic support to achieve the goal of an adequately perfused patient. Vitals should be monitored and taken frequently. Mrs. J requires daily monitoring of weight, fluid balance, electrolyte levels, serum creatinine levels, and signs and symptoms of congestion. Other serum tests such as BNP, liver function, D-dimer, and CBC are recommended.
1. IV furosemide (Lasix) – Administration of Lasix IV results in prompt diuretic effect (within 30 minutes). This effect leads to a decrease in ventricular filling pressures and improvement in symptoms in most patients with ADHF.
2. Enalapril (Vasotec) – Enalapril is a ACE inhibitor that inhibits a chemical called angiotensin converting enzyme. This widens your blood vessels and helps to reduce the amount of water put back into your blood by your kidneys. These actions help to decrease blood pressure. In Mrs. J’s case, there may be too much circulating fluid in her blood vessels and enalapril will help reduce this
At the start of her admission, Mrs. J is going through many complications throughout most of her systems. I would follow the rules of ABC and control her respiratory problem first. Mrs. J has an oxygen saturation of 82% and is probably going to continue dropping. She will require oxygen first, possibly a nonrebreather mask. The symptoms she is facing is of a person going through acute heart failure which includes shortness of breath, coughing/wheezing, weight gain, swollen ankles, rapid heart rate, tiredness/fatigue, and loss of appetite. With Mrs. J’s signs and symptoms, she must be hospitalized immediately. She requires inpatient monitoring. Telemetry monitoring should be initiated and continued for 24-48 hours after admission. She requires a combination of diuretics, vasodilators, and inotropic support to achieve the goal of an adequately perfused patient. Vitals should be monitored and taken frequently. Mrs. J requires daily monitoring of weight, fluid balance, electrolyte levels, serum creatinine levels, and signs and symptoms of congestion. Other serum tests such as BNP, liver function, D-dimer, and CBC are recommended.
1. IV furosemide (Lasix) – Administration of Lasix IV results in prompt diuretic effect (within 30 minutes). This effect leads to a decrease in ventricular filling pressures and improvement in symptoms in most patients with ADHF.
2. Enalapril (Vasotec) – Enalapril is a ACE inhibitor that inhibits a chemical called angiotensin converting enzyme. This widens your blood vessels and helps to reduce the amount of water put back into your blood by your kidneys. These actions help to decrease blood pressure. In Mrs. J’s case, there may be too much circulating fluid in her blood vessels and enalapril will help reduce this
References: Heart failure. (n.d.). Retrieved January 27, 2015, from http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/causes/con-20029801 Joseph, S., Cedars, A., Ewald, G., Geltman, E., & Mann, D. (n.d.). Acute Decompensated Heart Failure: Contemporary Medical Management. Retrieved January 27, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801958/ Myths and facts about heart failure. (n.d.). Retrieved January 27, 2015, from http://www.heartfailurematters.org/en_GB/Understanding-heart-failure/Myths-and-facts-about-heart-failure