Critical Thinking question-CHF patient case scenario

Nursing interventions

At the time of admission, the nurse should first put the patient on oxygen via nasal cannula. This will help raise the patient’s oxygen delivery to the tissues and increase the oxygen concentration levels. An intravenous access should also be established, and antihypertensive drugs started. A resuscitation tray should be prepared in case of emergency. Besides these, the nurse should explain the situation to the patient and reassure the family. This alleviates anxiety and helps in effective control of the vital signs.

Medications

IV Furosemide is a loop diuretic that acts on the kidneys to increase the loss of water in urine and thus reduce blood volume. This reduces the blood pressure(Opie, 2013).

Enalapril is an angiotensin-converting enzyme inhibitor that helps reduce the vasoconstrictive effects of angiotensin II. With dilated vessels, blood pressure reduces(Kudo & Thompson, 2015).

Metoprolol is a beta-blocker that helps reduce the heart rate by blocking the action potential in heart muscles. This reduces blood pressure and also control angina(Braunwald, 2013).

Morphine Sulphate is a strong opioid analgesic that helps prevent acute pains(Braunwald, 2013).

Diseases leading to heart failure

Heart failure may result from cardiovascular diseases such as heart valve disease, myocardial infarction, hypertension, or coronary artery disease. In heart valve disease, the valves controlling the flow of blood in the heart are defective and this leads to the poor emptying of the heart chambers, this increases the heart size and reduce its effectiveness. Drugs such as diuretics help control blood volume and prevent further damage as other interventions are undertaken. Continuous monitoring of the fluid levels and blood pressure are necessary interventions(Opie, 2013).

Myocardial infarction leads to the ineffectiveness of one part of the heart muscles due to poor oxygen delivery. Drugs to remove the infarction such as thrombolytic and continuous blood pressure control are recommended(Eleuteri & Di Stefano, 2012).

Coronary artery disease also causes degeneration of the heart tissues due to poor delivery of oxygen and nutrients. Drugs to control the condition include the blood pressure controlling drugs such as enalapril, furosemide, and propranolol. Habits that may lead to the disease such as smoking should be stopped and the nurse should advice the patient accordingly(Charlton & Thompson, 2015).

With increased pressure, the heart mal-performs and becomes exhausted leading to failure. Effective control of blood pressure is necessary with a combination of drugs such as diuretics, beta-blockers, and ACE inhibitors and also monitoring the pressure for action to be taken, as a nursing intervention(Charlton & Thompson, 2015).

Preventing drug interaction

A drug interaction can be prevented through adequate history taking to identify the drugs, studying and comparing mechanisms of action, monitoring the signs of interaction and involving the patient in prescription and administration of drugs(Kudo & Thompson, 2015).

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