Patho response 3

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please read the peers discussions and respond to them APA format with reference

Discussion 1

Mrs. J. is already diagnosed with congestive heart failure, which
occurs in association with other cardiac disorders from a number of
different causes (Copstead & Banasik, 2012). Heart failure is the
inability of the heart to maintain sufficient cardiac output to
optimally meet metabolic demands of tissues and organs and this
results in the end stage of most cardiac diseases.

Nursing interventions that are appropriate to Mrs. J. at the time of
admission. Considering the clinical manifestations that this patient
is presenting with, she is quite sick and the first issue to be
addressed is her airway and oxygenation saturation to ensure that she
is receiving enough oxygen to the brain and all other parts of the
body. She will need to be placed in bed, made comfortable and given
reassurance because she is anxious, worried and asking whether she is
going to die. Reassurance and company with a staff is important. Her
respiratory rate is rapid (34), Blood pressure is 90/58 so intravenous
fluids will not be recommended because she has congestive heart
failure however, because she is also put on intravenous
Lasix, she may need limited intravenous fluids sparingly. She has
palpitations with a heart rate of 118. Mrs. J. will be placed in
a room that is close to the nurses’ station and full of light
because she scared and will need to be watched closely.

Mrs. J. will need a 12 lead EKG after she has been placed in bed, IV
access placed, full blood work chemistry and urine collected, a chest
x-ray ordered because she is complaining of not getting enough air.
Blood cultures will be collected for because she may be having
infection as she Pharyngitis. She will also need Arterial blood gas
analysis to determine the oxygenation in her blood stream. She is also
reported to be anxious, and morphine injection is ordered which helps
to calm her down and also helps decrease the heart demand for
oxygen. Mrs. J. will need to be given supplementary oxygen
because she is complaining of not getting enough air and reassurance
continued. Gradually as her condition improves, education about
smoking will discussed as a way of helping towards improvement and may
be an alternative for smoking such as use of nicotine patch.

The rationale for giving intravenous furosemide (Lasix) is to help
in diuresis since she has fluid overload as evidenced by peripheral
edema (1+). Enalapril (Vasotec) is given because it is an ACE
inhibitor (angiotensin converting enzyme), which helps by blocking a
substance in the body that causes the blood vessels to tighten, and as
a result, enalapril releases the blood vessels, which lowers the blood
pressure and increases the supply of blood and oxygen to the heart.
Metoprolol is a beta-blocker that is given because it affects the
heart and circulation and is used mostly in hypertensive patients and
patients with irregular heartbeats as already noted in Ms. J. With a
ventricular rate of 132 and arterial fibrillation. Morphine
administration decreases the hear demand for oxygen and also as a
sedative for the patient.

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. One of the
conditions is Coronary heart disease which is a waxy substance called
plague that build inside the coronary arteries and it causes narrowing
of the arteries (National Heart, Lung, and Blood Institute, n.d.) thus
reducing the flow to the hear muscles and the build- up also makes it
more likely that blood clots in the arteries. This can be
prevent by taking a healthy diet that low in cholesterol,
exercising and also by having regular medical checkups and observing
the weight gain to ensure this is controlled.

Arrhythmias occurs when there change of the heart rates or rhythm of
the heart and can be due to some beverages like caffeine and drugs
like cocaine, amphetamines and marijuana. Education to those who are
prone or predisposed to those drugs is the nursing intervention and
creating awareness and effects of those substances.

Myocarditis which is the inflammation of the heart muscles can
result from infections such as sore throat and other infections.
Nursing education for effective treatment and taking of antibiotics is
important and those that fall sick need to seek medical attention.

Hypertension will need to be treated and ensure that patients with
hypertension take their medications and measure their blood pressure
regularly and also minimize consumption of fatty and salty foods,
Exercising daily even simple walking for 30 minutes can be helpful.

Taking into consideration the fact that most mature adults take at
least six prescription medications, four nursing interventions that
can help prevent problems caused by multiple interactions in older
patients can be: Clear education and information about medications.
Medications need to be accurately listed and there is need to discuss
the dosages and the frequency of taking medications. If the patient
cannot read, a family member needs to be educated on the medications
the patient is taking to ensure proper supervision. Patients need to
be informed why they are taking the medications and also and the
danger to take an overdose.

“Polypharmacy refers to the effects of taking multiple
medications concurrently to manage coexisting health problems”
(Woodruff, 2010). Patients taking many medications need special
containers which are clearly labeled with the frequency and times that
the medication needs to be taken. Patients will clearly need
supervision of the medications they are taking. Patients need to
be aware not to share medications and also store medications in a
secure dry area away from light to prevent decomposition and loss of
potency. Old medications and expired drugs should be disposed.

Color coding of different medications is very important as the
patient will keep a memory of the color codes. Most important,
physicians and health providers should minimize the number of
prescription drugs for older adults and keep dosing schedules simple
and also avoid change of medications frequently if possible. Also use
of single medicines for the illness than prescribing multiple
medications for the same illness or condition.

Reference

Copstead, L.C. & Banasik, J.L. (2012). Pathophysiology
(5th ed.). St. Louis; MO.Retrieved from http://evolve.elsvier.com/Copstead

National Heart, Lung and Blood Institute. (n.d.). Heart failure.
Retrieved from https://www.nhlbi.nih.gov/health-topics/heart-fail…

Woodruff, K. (2010). Preventing polypharmacy in older adults.
American Nurse Today. 5 (10), 1-7, Retrieved from https://www.americannursetoday.com/preventing-poly…

Disccussion 2

  1. What nursing interventions are appropriate for Mrs. J. at the
    time of her admission?

At time of Admission Mrs. J requires intervention for her breathing.
Not only does Mrs. J feel that she cannot get enough oxygen, she
reports feeling weak, and extremely anxious, which is all signs of
poor oxygenation. With a SpO2 of 82% Mrs. J requires supplemental
oxygen. Mrs. J also has blood tinged, frothy sputum which is a sign of
pulmonary edema (pulmonary edema, 2018). Along with the decreased
breath sounds, pulmonary crackles Mrs. J is not only starting
respiratory failure she is also experiencing left sided heart failure
and the build up of fluids. Mrs. J needs Lasix to help her body start
to get rid of the excess fluid in her system. With a prolonged period
without the proper amount of oxygen in the body Mrs. J heart could
suffer the consequence. “When metabolic demand for oxygen
exceeds supply, the myocardium becomes ischemic, which leads to a
dysfunction in cardiac pumping and predisposes to abnormal heart
rhythms. If the ischemic episode is severe or prolonged, irreversible
damage to myocardial cells may result in MI” (Copstead-Kirkhorn.
(2010) page 429)

Mrs. J should get an EKG if it was not already done in the Emergency
room to get a good look at the heart. With atrial fibrillation Mrs. J
has an increase risk for experiencing a stroke. When listening to the
heart S3 sounds are present. S3 sounds could indicate ventricular
failure. “The third heart sound (S3), when audible,
occurs early in ventricular filling, and may represent tensing
of the chordae tendineae and the atrioventricular ring, which is the
connective tissue supporting the AV valve leaflets. This sound is
normal in children, but when heard in adults it is often associated
with ventricular dilation as occurs in systolic ventricular
failure” (Heart Sounds, para 3).

Mrs. J has been not taking care of herself for a while and finds
herself critically ill. She is feeling anxious due to not being able
to breath properly, due to hospitalization, and fear of the unknown.
Nurses should do their best to explain everything that they are doing
to Mrs. J. short, simple explanations can help a patient feel more at
ease about the situation, and put trust in the health care staff
caring for them.

  1. Drug therapy is started for Mrs. J. to control her
    symptoms. What is the rationale for the administration of each of
    the following medications?
  1. IV furosemide (Lasix): Promotes diuresis and the excretion of
    excess fluid. Used with heart failure patients and with hepatic
    impairment. We know due to the jugular vein distention, crackles
    in lungs, pulmonary edema, and other signs and symptoms Mrs. J has
    that she has excess fluid in her body that her body is unable to
    get rid of on its own. Lasix helps excrete the fluid. Although the
    main concerns we were looking at is heart failure, it is indicated
    that Mrs. J has hepatomegaly, so she may have issues with her
    liver as well. (Vallerand, Sanoski, & Deglin, 2017)
  1. Enalapril (Vasotec): An ACE inhibitor used in the management
    of hypertension in patients with heart failure. This medication is
    used because of Mrs. J’s comorbidities and due to her having
    heart failure signs and symptoms. (Vallerand, Sanoski, &
    Deglin, 2017)
  1. Metoprolol (Lopressor): Beta blocker that is used in
    combination with ACE inhibitors for management of hypertension and
    is used in patients with heart failure. “Indications
    Hypertension. Angina pectoris. Prevention of MI and
    decreased mortality in patients with recent MI. Management of
    stable, symptomatic (class II or III) heart failure due to
    ischemic, hypertensive or cardiomyopathc origin (may be used with
    ACE inhibitors, diuretics and/or digoxin; Toprol XL only)”
    (Vallerand, Sanoski, & Deglin, 2017).
  1. IV morphine sulphate (Morphine): an opioid analgesic that is
    usually used for pain. However, morphine can also be used for
    pulmonary edema. Morphine also helps anxiety and reduces oxygen
    demand. (Vallerand, Sanoski, & Deglin, 2017).
  1. 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.

1.Atherosclerosis: “Atherosclerosis causes progressive
narrowing of the arterial lumen and predisposes to a number of
processes that can precipitate myocardial ischemia, including thrombus
formation, coronary vasospasm, and endothelial cell dysfunction”
(Copstead-Kirkhorn. (2010) page 429) Medications that help with
atherosclerosis is statins, aspirin, and angiotensin inhibitors.
Nursing interventions include: assisting with smoking cessation,
control of diabetes, and dietary changes to promote healthier lifestyle.

2. hypertension: patients should take prescribed blood pressure
medication and follow up with primary doctor to determine
effectiveness. Nursing interventions include, smoking cessation,
instructions on taking medication, and exercise.

3. cardiomyopathy: is enlargement of the heart from infections or
drug and alcohol abuse. (“Congestive Heart Failure and Heart
Disease”, 2018). Nurses can assist patients in getting rehab for
drug addiction and teach a sober lifestyle.

4. valve disease: can increase the work load of the heart which can
increase risk for heart failure. (“Congestive Heart Failure and
Heart Disease”, 2018) nurses should teach patients to lead active
healthy lifestyle and to look for signs and symptoms of heart failure
like swelling, and report to primary doctor as soon as signs begin.

  1. 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.
  1. Nurses should assist patients in organizing. Many times, when
    patients have a lot of medication it is easy to forget to take
    medication, or can not remember if they took the medication, and
    they take it again accidently double dosing themselves. Getting a
    medication organizer can reduce these errors and help patients take
    their medication as appropriate. (“Preventing polypharmacy in
    older adults”, 2017)
  1. Technology has greatly assisted in checking for drug
    interactions. “Advances in information technology, such as
    electronic prescribing, electronic medical records, and electronic
    laboratory records, are innovative ways to decrease the risk of
    adverse drug reactions and interactions” (“Preventing
    polypharmacy in older adults”, 2017)
  1. Limiting health care providers could help in the safety of
    medication. When a patient sees a new doctor, they should provide a
    detailed list of all medications and supplements they are taking.
    The patient should inform their primary doctor of any medication
    changes the new doctor wishes to make before implementing the
    change. (“Preventing polypharmacy in older adults”,
    2017)
  1. Nurses should teach patients about any dietary restrictions
    that their medication requires, and nurses should teach potential
    side affects so the patient knows what to expect and when to seek
    emergency care. “Inform patients of any dietary restrictions
    necessitated by a specific medication. During healthcare
    appointments, teach the patient about potential side effects,
    including when to call the clinic or go to the emergency room”
    (“Preventing polypharmacy in older adults”, 2017)

Reference

Copstead-Kirkhorn. (2010). Pathophysiology, 4th Edition.
[Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978141605…

Congestive Heart Failure and Heart Disease. (n.d.). Retrieved June
19, 2018, from https://www.webmd.com/heart-disease/guide-heart-fa…

Heart Sounds. (n.d.). Retrieved June 18, 2018, from
http://www.cvphysiology.com/Heart Disease/HD010

Preventing polypharmacy in older adults. (2017, September 19).
Retrieved June 19, 2018, from https://www.americannursetoday.com/preventing-poly…

Pulmonary edema: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved
June 18, 2018, from https://medlineplus.gov/ency/article/000140.htm

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017).
Daviss drug guide for nurses. Philadelphia: F.A. Davis
Company. Retrieved June 18, 2018, from search.ebscohost.com/login.aspx?direct=true&db=nrc&AN=2009535797&site=nrc-live.

Discussion 3

Mrs. J’ symptoms
are typical of congestive heart failure (CHF), which occurs when
the heart cannot provide adequate oxygenation or nutrients to the
body. Her presenting symptoms at admission, as well as her
cardiovascular and pulmonary findings are of left ventricular
failure. Patients often appear anxious, have a productive cough,
hypoxia, and an enlarged liver. Her tachycardia, tachypnea,
and hypotension are all due to her state of decompensation. Her S3
present with a ventricular rate of 132 and atrial fibrillation are
of concern as well.

The
decreased cardiac output will be affecting vital organs. Mrs. J is
already retaining fluid, thus the need for furosemide. Loop
diuretics are used for the symptomatic relief of sodium and water
retention. Beta-blockers (metoprolol), and angiotensin-converting
enzyme (ACE) inhibitors have been the main medical treatment of
choice for CHF for decades. They work by neurohormonal suppression
and reducing the ejection fraction (Oni-Orisan & Lanfear, 2014).
Digoxin is another drug that could be used but at very low levels.
Morphine is usually prescribed in the sickest patients, although
recent literature shows it can cause some harm as well (Agewall,
2017). In this case, it was probably used for lowering her
heart rate and respiratory rate, but it can also cause respiratory depression.

Acute MI, tachycardia,
bradycardia, fluid and salt retention are some conditions that can
lead to heart failure. Nurses and physicians must assess
patients with these symptoms for any signs of knowledge deficit
regarding the causes of their conditions and educate them on the
importance of taking their medications as prescribed, to prevent
further medical complications. Many of these patients face
the issue of polypharmacy. In many cases, if the patient
does not have enough money they may choose to take one drug over
the other one. I had a patient that stopped taking his blood
pressure medicine because at the last visit his BP was
normal. I explained to him the reason it was normal it was
because of the medication. The risk of drug interaction is
one that the nurse should be aware of and be able to review the
list of medications with the patient at each visit. She
should recommend to the patient to always fill the prescriptions
at the same pharmacy, so there is a record of all the medications
taken for the pharmacist to be able to contact the prescriber of
any drug interactions. The nurse, as a patient advocate,
should assess for any financial, economic or social conditions
that may keep the patient from taking the prescribed medications
and follow-ups in the clinic.

References

Agewall,
S. (2017, July, 2017). Morphine in acute heart failure. Journal
of Thoracic Disease
, 9(7), 1851-1854. https://doi.org/10.21037/jtd.2017.06.129

Oni-Orisan,
A., & Lanfear, D. (2014). Pharmacogenomics in heart failure:
where are we now and how can we reach clinical application.
Cardiology in Review, 22(5), 193-198. https://doi.org/10.1097/CRD.0000000000000028.

Discussion 4

The nursing interventions that are appropriate for Mrs. J at the time
of her admission is to immediately get her hooked up to a continuous
heart rate monitor, have her sit in a high fowler’s position to
promote better respirations and keep her calm. It can be a
scary thing being admitted to the hospital. Often times
when a patient is first admitted, so many things are happening at
once, nurses and other health care professionals forget to take a step
back and see if the patient is okay, if they have any immediate
questions, ease their fears and anxiety and just being a caring hand
to hold.

The rationale for initiating IV Lasix is to eliminate the excess
water in Mrs. J’s body. According to Ogbru (2018b),
when Lasix is administered its function is to block the absorption of
water, sodium and chloride by the body. By doing this there is a large
increase in urine production. Mrs. J had pulmonary crackles
and decreased breath sounds which could indicate she is fluid overloaded.

Vasotec was also initiated for Mrs. J to relieve the symptoms she
was experiencing. Vasotec is an ACE Inhibitor. An ACE inhibitor stands
for Angiotensin Converting Enzyme Inhibitor. These types of
medications enlarge the blood vessels which allows the heart to pump
blood easier and lower a person’s blood pressure (Ogbru, 2018a,
What are ACE inhibitors and How Do They Work
Section). Because Mrs. J is exhibiting signs of worsening
heart failure, administering an ACE inhibitor such as Vasotec will
allow her heart to pump the blood slower which will improve her hearts
overall function.

Lopressor is a beta blocker. A beta blockers job is to block
norepinephrine and epinephrine at their receptor sites (Kow & Ong,
2011). By doing this, Mrs. J’s increased heart rate will slow
down which means that her heart will be beating with less force.

Morphine was also administered to Mrs. J. When people think of
Morphine, they usually think of a narcotic that relieves pain.
Although there are not many studies to support it fully, morphine can
be given in the early stages of acute heart failure due to its
sedative and also hemodynamic properties. Morphine can reduce the
hearts oxygen demand by decreasing the preload and heart rate (Coons,
McGraw, Murali, 2011, para. 1). Giving Morphine to Mrs. J will not
only relax her in this tense and scary situation she is going through,
it can also provide more oxygen to her heart by almost relaxing it.

There are many things that can contribute to a person having heart
failure. Having coronary artery disease can lead to heart
failure. Coronary artery disease is when the arteries of
your heart have a build of up cholesterol. This means that
less blood is able to flow through freely. This buildup in
the arteries can lead to an increase in blood pressure which lead can
lead to heart failure (American Heart Association,
2017). Being obese can also be a contributing
factor. Because of the excess weight, it causes the heart
to work harder compared to a non- obese person. Being a diabetic can
also increase a person’s risk for developing heart
failure. People who have diabetes, especially Type II
diabetes, tend to be overweight, lack physical activity, have an
increased cholesterol level and elevate blood pressures (American
Heart Association, 2018). All of these things that accompany the
diabetes increase a person’s risk greatly for heart disease.
Hypertension is another cardiovascular condition that may eventually
lead to heart failure. When a person’s pressure within
their blood vessels remains high, it means that the heart is having to
work much hard to pump the blood throughout the body. If it goes
uncontrolled and not properly treated it can cause the chambers of the
heart to become much weaker and larger, which then can increase your
risk for heart failure (American Heart Association, 2017). Also, if
someone has suffered a heart attack before has a much higher risk of
developing heart failure compared to others. Having a heart attack
damages the muscle tissues of the heart which means that the heart
does not contract as easily as it did before making it pumping
abilities weaken (American Heart Association, 2017).

To prevent heart failure in patients with each of these
cardiovascular conditions the first nursing intervention that should
be done is education. If a patient is not properly educated on the
reasons they are being treated for the condition they have, on the
medication they may be taking, signs and symptoms of heart failure,
when they should seek medical attention, and what could happen if they
do not treat their cardiovascular condition, it puts them at greater
risk. In addition to education, for a person with coronary artery
disease, ensuring that they are adhering to a proper diet that can
reduce their cholesterol intake and making sure they are taking any
medications that they are prescribed. For obesity, assisting with
exercise regimens, referring them to support groups and education on
consuming a healthy and well- balanced diet to help them to lose
weight can decrease their risk of heart failure. For a diabetic
patient, making sure that their blood sugars are well controlled,
their following a proper diabetic diet, increasing their physical
activity and taking their medication as ordered. Patients with
Hypertension should check their blood pressure on a daily basis as
well as their medication. Checking their blood pressure daily will
ensure that they are on the proper medication, it is the right dose
and their blood pressures are normotensive. Also, decreasing sodium
intake and eating a diet high in fruits and vegetables and increasing
physical activity can also decrease their blood pressure without the
use of medications. All of these conditions also require that the
patients are seeing their doctor on a regular basis and getting any
lab tests done that are required.

As a person grows older, more health issues usually arise which
means that the older you get, the more medications you are
taking. This can sometimes be confusing for the older
adult. They can get confused on when to take which pill, how many
times a day, if they have to take the pills with food or should they
be on an empty stomach, or if any of the medications have interactions
with each other. A nursing intervention to prevent drug interactions
is medication education. Providing detailed yet easy to understand
education on the medication such as what that medication is for,
common side effects, when to take it and what to not take it with.
Another nursing intervention to go along with the first intervention
is to keep an accurate list of each medication. This list should
include both the generic names and any brand names it may have, a
picture of what the medication looks likes, the purpose of it and the
side effects. Keeping a list like this posted on a cabinet door or
somewhere where the medications are stored allows the patient easy
access to if and when there should be a question about the
medication. Sometimes medication bottles can be confusing
and the print on them is hard to read. Taking each medication and
placing it in a new container labeled largely with the name of the
medication, time it should be taken, and what to avoid taking it with
on the top is a fool proof way for older patients to not miss taking a
dose and avoid taking it the incorrect way. Lastly, another way to
reduce the risk for drug interactions is to urge older patients not to
share medications. Medications can be very costly. However, sharing
medications between friends or family to save money may cost you in
other ways. By not sharing medications with others you avoid the risk
of overdosing, taking a medication that you are not prescribed, taking
a medication that could interfere with another one you are already
taking or taking a medication that you could have a allergic reaction to.

References:

American Heart Association. (2017, May 8). Causes of Heart Failure.
Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

American Heart Association. (2018, January 29). Cardiovascular
Disease and Diabetes. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/Diab…

Coons, J. C., McGraw, M., & Murali, S. (2011). Pharmacotherapy
for Acute Heart Failure Syndromes. American Journal of
Health-System Pharmacy,68
(1), 21-35. Retrieved from https://www.medscape.com/viewarticle/735149_8.

Kow, F. P., & Ong, H. T. (2011). Beta-blockers for heart
failure: Why you should use them more. The Journal of Family
Practice,
60(8), 472-477. Retrieved from https://www.mdedge.com/jfponline/article/64412/cardiology/beta-blockers-heart-failure-why-you-should-use-them-more.

Ogbru, O. (2018a). ACE Inhibitors Drug Class Side Effects, List of
Names, Uses, and Dosage. Retrieved from https://www.medicinenet.com/ace_inhibitors/article…

Ogbru, O. (2018b). Furosemide. Retrieved from https://www.medicinenet.com/furosemide/article.htm…

Discussion 5

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?

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)

Given the condition that Mrs. J. is suffering from, the best
interventions that are appropriate at the time of her admission would
include administration of oxygen thru intubation since she has
difficulty in breathing, administration of diazepam or any anxiolytic
which could allow the patient to relax and finally provide an
antibiotic that would help her manage the respiratory infection
specified by pharyngitis.

What is the rationale for the administration of each of the
following medications?

IV furosemide (Lasix)

Administration of IV furosemide (Lasix) will help decrease
extravascular volume by persuading diuresis therefore reducing preload
and the work of the heart in pumping blood is decreased hence prevent
progression of heart failure.

Enalapril (Vasotec)

Given that Enalapril is an ACE inhibitor (angiotensin-converting
enzyme inhibitor), which prevents the constriction of blood vessels.
As a result, it leads to the vasodilation of peripheral vessels
preventing the prevalence of heart failure.

Metoprolol (Lopressor)

Despite being used as a beta-blocker which affects the heart and
circulation (blood flow through arteries and veins), metoprolol is
used in the treatment of angina (chest pain) and hypertension (high
blood pressure). It can be used in this case to prevent possible cases
of heart attack.

IV morphine sulphate (Morphine)

This drug belongs to a class of drugs known as opioid (narcotic)
analgesics whose main role is management of pain.

Describe four cardiovascular conditions that may lead to heart failure

Different cardiovascular conditions exist that may lead to heart
failure, for instance,

Coronary artery disease: This mainly
lead to heart failure when cholesterol and fatty
deposits build up in the heart’s arteries, limiting the amount of
blood reaching the heart muscle. This build-up is known as
atherosclerosis. The result may be chest pain (angina) or, if blood
flow becomes totally obstructed, a heart attack.

Myocardial infarction: this can occur when an
artery that supplies blood to the heart muscle gets blocked. The loss
of oxygen and nutrients damages the heart’s muscle tissue – part
of it essentially “dies.” The damaged heart tissue does not
contract as well which weakens the heart’s ability to pump
blood, hence, leading to heart failure.

High blood pressure (hypertension or HBP): this is a
major risk factor for developing heart failure. When pressure in the
blood vessels is too high, the heart has to pump harder than normal to
keep the blood circulating. This takes a toll on the heart, and over
time the chambers get larger and weaker; that can as a result lead to
heart failure.

what can be done in the form of medical/nursing interventions
to prevent the development of heart failure in each condition.

To prevent the occurrence of heart failure monitoring the blood
pressure is important to prevent abnormal blood pressure hence
overworking the heart. Monitoring the blood sugar can help prevent
hypertension and atherosclerosis from leading to elevated lipid levels
in the blood, the monitoring can also help prevent and decrease the
blood sugar levels. Also, monitoring the levels of cholesterol can
help reduce chances of getting coronary artery disease that can later
lead to heart failure.

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

The nursing interventions that could help prevent problems caused by
multiple drugs interactions in older patient include;

Maintaining an accurate list and record of all drugs administered to
the patient. The process is important since it can help the physicians
understand the medications they administered to the patient hence
preventing addition of the same medications.

Patient education. This would include giving sufficient info to the
patient to keep an updated status between the physician and the
patient, hence helping to guide the patient on the right drug to use
and at which period.

Also, helping the patient to manage their drugs by assigning a
homecare nurse can ensure that the patient completes the drugs and
disposes expired medications.

References

American Heart Association (2017). Causes of Heart Failure.
Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A.,
Böhm, M., Dickstein, K., … & Jaarsma, T. (2012). ESC
Guidelines for the diagnosis and treatment of acute and chronic heart
failure 2012. European journal of heart
failure
, 14(8), 803-869.

MayoClinic (2017). Diseases and Conditions: Heart failure. Retrieved
from https://www.mayoclinic.org/diseases-conditions/hea…

Discussion 6

In the event of Mrs. J it would be appropriate to say that her
admission due to acute decompensated heart failure is due to her
noncompliance of not taking her heart medications for 4 days and
continuous smoking history. Although her diet is unknown it could also
be an affect to her current condition. In congestive heart failure
(CHF) there is a problem with the pumping of the heart making it
difficult for the heart to pump blood to the rest of the body and
causing a backup flow of fluids to your lungs and body, (Health Line,
2018). In Mrs. J’s case her heart and blood medication are to
help her keep her CHF controlled and when noncompliant along with
other things like poor diet and exercise, it can cause acute heart
failure, a worsening of her uncontrolled CHF, where new onset symptoms
can arise, (Arrigo, Parissis, Akiyama, & Mebazaa, 2016).
Which in Mrs. J’s case she has developed difficulty
breathing, palpitations, and exhausted.

Upon admission the appropriate interventions for Mrs. J is to first
to provide her oxygen supply due to her difficulty breathing and pulse
oximetry of 82%. These signs indicate that she is not receiving enough
oxygen on room air, therefore administering oxygen is appropriate.
Sitting her up in high fowlers is also the appropriate intervention
because she is experiencing fluid buildup, in other words retaining
fluid, as evidence by pulmonary crackles, and decrease breath sounds.
Laying her flat can create more fluid to backup into the lungs causing
greater difficulty in breathing. Appropriate medications should be
administered as well as a continuation of cardiac assessment, vital
signs, and monitoring is essential for any changes in condition.

Medications like furosemide (Lasix) is administered to move fluid
that is build up in the lungs and body out the body through urination.
Furosemide (Lasix) is a loop-diuretic that acts on the kidneys to
produce urine from the fluid buildup in the body which helps the
excess fluid to be removed through urination and out of the body,
(Health Line, 2018). In Mrs. J’s case it will help the fluid
buildup in her lungs and body to be removed and help improve her condition.

Enalipril (Vasotec) is an angiotensin-converting enzyme inhibitor
(ACE inhibitor) that is used for blood pressure, and CHF. It helps the
vessels to dilate so that blood can properly flow to your heart and
body, therefore improving blood flow, (Health Line, 2018). In Mrs. J
case Enalapril is given to help the blood flow so that the heart is
able to pump more easily.

Metoprolol (Lopressor) is a beta-blocker that can reduce high blood
pressure as well as rapid uncontrolled heart rate, therefore used to
slow and control the heart rate to normal rate, (Health line, 2018).
In Mrs. J’s case it given to control her rapid heart rate of 118
and irregularity.

Morphine is a an opioid that is used for pain, however reported to
reduce preload, heart rate, and afterload and help dilate the vessels
which in CHF is needed to help reduce the oxygen demand in the heart,
it is also know to decrease anxiety and help relaxation for better
breathing, (Coons, McGraw, Murali, 2011). In Mrs. J’s case
she is having heart failure symptoms of her heart overworking causing
her a rapid heart rate and difficulty breathing that is giving her
anxiety. Morphine will her fell less anxious and decrease her feeling
of not being able to breath.

There are many cardiovascular conditions that can lead to heart
failure like hypertension, coronary artery disease, abnormal valves,
and damage to the heart like cardiomyopathy or a previous heart attack.

Hypertension is known as high blood pressure. It is when the
pressure in the heart is too high and has to puck harder than normal
to get blood to flow causing an overwork on the heart, (American Heart
Association, 2018). It is important that as a nurse the patient is
educated on the importance of blood pressure control through exercise,
diet, and medication compliance.

Coronary artery disease is due to high cholesterol in blood and
plaque build-up in the arteries causing obstruction of blood flow
which can lead to chest pain and heart attack causing heart failure,
(American Heart Association, 2018). As a nurse education on a
healthy diet and exercise is essential to control cholesterol. Medical
interventions like cholesterol medications or if more serious cardio
procedures like stenting of the heart is appropriate.

Abnormal Valves in the heart is a defect on the valves of the heart,
a malfunction where they do not close or open properly causes the
heart to overwork and over stress itself that eventually can result to
heart failure, (American Heart Association, 2018). In this situation
education about the heart valves and following up with a cardiologist
is essential procedures to repair the defected heart valves.

Cardiomyopathy is an enlarged heart due to heart damage. The damage
can be from drug use, birth defects, heart attack or unknown reasons,
(American Heart Association, 2018). The appropriate interventions are
to regularity follow up with a cardiologist, cardiac medications, and
cardiac diet.

Polypharmacy is referred to the effects of too many drug
administrations, (American Nurses Today, 2018). Many older adults take
more than three prescription drugs due to multiple health issues,
therefore medication management is very important to help prevent drug
interactions, miss doses, or even drug overuse. As a nurse to help
polypharmacy risk in patients from occurring it is important to
discuss the medications with patients and the importance of having an
up to date medication list of all prescription and over the counter
medications, vitamins, herbal, doses, frequency, and reason (American
Nurses Today, 2018). It is important that they keep the list updated
and that they provide a copy to all care providers as well as use the
same pharmacy for all prescriptions to avoid confusion. This is
important to avoid duplication and drug interactions. It is important
to teach the patient what each drug is for and what it does so that
they have an understanding of why the drug is needed and important to
take as directed. It is also important to teach them about abnormal
signs when taking current or new medications, and when it is essential
to report to a healthcare provider, this will help avoid any urgent or
emergency situation, (American Nurses Today, 2018). For some older
patients remembering to take medications and the purpose can be
difficult to remember, therefore organizing daily medications by
separating morning and night using a pill/medication organizer can
help ,as well as teaching them the colors of each pill, (American
Nurse Today, 2018). This will help avoid confusion and help remind
them to take their pills daily.

References

American Heart Association. (2018). Causes of heart Failure.
Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

American Nurses Today. (2018). Preventing Polypharmacy in Older
Patients. Retrieved from https://www.americannursetoday.com/preventing-poly…

Arrigo, M., Parissis, J., Akiyama, E., Mebazaa, A. (2016).
Understanding acute heart failure: pathophysiology and diagnosis.
European Heart Journal Supplements, Vol 18. Pg. G11-G18. Retrieved
from https://academic.oup.com/eurheartjsupp/article/18/…

Coons, J., McGraw, M., Murali, Srinivas. (2011). Pharmacotherapy for
Acute Heart Failure Syndromes. Retrieved from https://www.medscape.com/viewarticle/735149_8

Health Line. (2018). What are the most common types of CHF?.
Retrieved from https://www.healthline.com/health/congestive-heart…

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