Clinical Manifestations
Mrs. J is diagnosed with chronic heart failure, associated with inadequate perfusion of organs and tissues at rest or during exertion. During exacerbation of heart failure, Mrs. J has characteristic clinical manifestations in shortness of breath with minor physical exertion, limited ability to work, coughing fits, and restlessness. Nervousness and anxiety most often serve as the first signs of exacerbation of heart failure. In addition, objective data confirm left ventricular heart failure: PMI at sixth ICS and faint, bilateral jugular vein distention. In addition to the signs of heart failure, Mrs. J has signs of exacerbation of COPD: increased breath sounds, cough with bloody sputum. In addition, a low saturation of only 82% was noted.
Adequacy of First Interventions
Among the first interventions to resolve heart failure is fast-acting diuretics. Taking Lasix blocks the transport of sodium and potassium ions, which promotes increased urine excretion. It significantly reduces pulmonary artery pressure and left ventricular filling pressure, which is necessary for heart failure patients. Taking enalapril (Vasotec) helps to lower high blood pressure. This drug is also needed to improve hemodynamics and reduce the size of the left ventricle, so its administration is also rational. Taking Lopressor is mediated by its ability to prolong its effects (about 12 hours), and since the patient has hypertension in her diagnosis, its use is necessary.
Morphine is thought to prevent pulmonary edema and reduce dyspnea in heart failure. Mrs. J complained of shortness of breath and a racing heart, so the morphine was rational, but the dose was necessary. The administration of salbutamol (ProAir HFA) is required to relieve COPD symptoms. However, given the use of Lasix, there may be a risk of low sodium levels, which will also be detrimental to the heart. Its use should be reconsidered, and a milder drug should be chosen. The use of inhaled steroids is irrational because there is no reliable data on reducing worsening cardiovascular effects (Jing, Li, & Xu, 2018). In this regard, the administration of Flovent HFA may have been a mistake and worsened the patient’s condition. The use of oxygen through nasal cannulas reduces the load on the heart, and it is rational.
Potential Cardiovascular Conditions Leading To Heart Failure
Many conditions can lead to heart failure and need to be prevented. Coronary heart disease is the most dangerous condition due to a buildup of fatty deposits in the arteries. To prevent it, it is worth changing your physical activity and, at the very least, following a micronutrient-rich diet (Virani et al., 2020). Another disease is arterial hypertension, which is also prevented by diets high in potassium, calcium, and antihypertensive drugs. Myocarditis occurs due to the body’s low immune defense: viruses most often cause the disease. Nurses may recommend hardening, vaccinations (flu, polio, measles), and prevention of bad habits. Arrhythmia always poses excellent risks for heart failure because it constantly puts extra work on the heart. Prevention is possible with a normal state of the nervous system and compliance with the regime of the day.
Nursing Interventions to Prevent Problems Caused By Multiple Drug Interactions
Almost all patients over the age of 60 take multiple medications simultaneously, so nurses should educate patients and help prevent potential problems due to polypharmacy. First and foremost, patients should be educated about the drugs and the rationale for their use to avoid abuse. Second, nurses should arrange medication administration (timing and dosing) because medication sharing or unsafe storage will harm patients (Rankin et al., 2018). Third, nurses can evaluate medication interactions and monitor medication effectiveness – this avoids unnecessary medication use. Fourth, teaching patients to assess their condition will significantly reduce the risk of harmful effects.
Health Promotion and Restorative Teaching Plan
Mrs. J has a diagnosis of CHF and COPD, so she needs a combination of diagnostic, pharmacological, and rehabilitative interventions. A multidisciplinary approach will provide the best results because it will act on several pathological factors. It is worth including physical exercises: they will increase the peak oxygen consumption rate and improve the oxidative characteristics of the skeletal muscles. Endurance training will be beneficial to spread of obstruction and improve hemodynamics (Vitacca & Paneroni, 2018). Modified techniques include Nordic walking, which stimulates normal blood flow. In addition, the most crucial part is a healthy lifestyle: quit smoking, take proper medication, and use oxygen adequately.
Method for Providing Education
Education should begin with health literacy: Mrs. J is aware of her illnesses but lacks knowledge of why stopping her medications causes her condition to worsen. The nurse should write detailed instructions in plain language so that the patient understands the purpose of the drug. Visual memory will be helpful: handouts with education, prevention, and medication schedules will help them develop intuitive reflexes to take their medications correctly. Since Mrs. J has stopped taking her medication before, we need to establish her reasons: perhaps the cost or the risk of becoming addicted frightens her.
COPD Triggers
Many factors can trigger COPD exacerbation: for Mrs. J, the first such trigger is smoking. To reduce tobacco use, health care providers can explain what risks smoking stimulates: perhaps after an exacerbation, Mrs. J will take these words seriously. Group counseling would also be helpful because it would strengthen the resolve to address tobacco. Among other triggers of COPD, the most dangerous are air pollution and respiratory infections, which increase the strain on the bronchial tree.
References
Jing, X., Li, Y., & Xu, J. (2018). Risk of cardiovascular events associated with inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease: A meta-analysis.Canadian Respiratory Journal, 2018, 7097540. Web.
Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., Ryan, C., & Hughes, C. (2018). Interventions to improve the appropriate use of polypharmacy for older people. The Cochrane Database of Systematic Reviews, 9(9), CD008165. Web.
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., Djousse, L., Elkind, M., Ferguson, J. F., Fornage, M., Khan, S. S., Kissela, B. M., Knutson, K. L., Kwan, T. W., Lackland, D. T., Lewis, T. T., … American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2020). Heart disease and stroke statistics-2020 update: A report from the American heart association. Circulation, 141(9), e139–e596. Web.
Vitacca, M., & Paneroni, M. (2018). Rehabilitation of patients with coexisting COPD and heart failure.COPD, 15(3), 231–237. Web.