Table of Contents
Nursing Intervention 1:
Nursing Intervention 2:
Nursing Intervention 3:
Nursing interventions 4.
Brian Edwards, a 67-year-old man with a four-day medical history, has been history of worsening exertional hypoxia and dyspnoea. He was admitted to Ward 9A in this morning for the diagnosis of Chronic Heart Failure (CHF) for the management of hypoxia and dyspnea, and the hypertension was taken to the emergency department with three days of worsening shortness of breath and bilateral lower extremity swelling. Moreover, he testified paroxysmal nocturnal dyspnea and 3-pillow orthopnea for 2 days. Moreover, he has no reports of palpitations, chest pain, cough, fever, sputum production, or diaphoresis. In the morning time, he was hospitalized with the symptoms as well as diagnosed with acute exacerbation of CHF. At the time of this admission, he was not able to provide the dose or name of his current medications. In this way, decreased cardiac output associated with exacerbations of chronic heart failure to cardiomyopathy. As evidence by lower limb oedema, pulse loss BPM, BP 145/80 mmHg.
Significant symptoms were as follows: blood pressure 145/80 mm Hg, temperature 98.7°F, the heart rate 104 beats/ min, respiratory rate 24 breaths/min, and oxygen saturation (Spo2) increased by 88% on the ambient air that improved to 92% with 2 L oxygen per minute by nasal cannula. The patient has difficulty breathing; However, there is no use of side muscles. Cardiac tests are performed at a tachycardia, normal rhythm, normal S1 and S2 heart sounds with audible S3 gallop as well as the visible jugular venous distension of 6 cm above the sternal angle. A lung test found that the BBC was not concerned. Along with that, his abdominal test showed palpation of the liver 2 finger-breadths under the costal margin of the ribs with no considerable tenderness. The rest of the tests are not passable.
Although the symptoms showed him as the cause, he was removed from the hospital with signs of a traffic jam. Also, he was not discharged on the guideline-directed medical therapy. Moreover, GDMT for heart failure contains an angiotensin-converting enzyme and beta-blockers. Along with that, Beta blockers that have been shown to be effective in heart failure include bisoprolol, carvedilol, or metoprolol succinate. Anti-aldosterone supplementation has also been shown to cause EF deficiency in chronic heart failure. However, given the current social status of renal insufficiency and the treatment of infertility, anti-aldosterone therapy may be appropriate until an acute outpatient procedure is performed where electronic levels can be closely monitored. Since patients suffer from ischemic heart disease and are at risk of recurrence, high-intensity statins should also be included in the sweating procedure.
After Brian Edward being admitted in the Curtin Hospital, firstly the nurse tried to analyse the history of the patient. Then, the urine inflow quantity is rated along with the time duration of it. After each and every hour, it is noted to identify any sort of internal kidney problems are present within the body. Moreover, whether the patient shows any sort of diabetic symptoms or not. At the same time, the quantity of the urine also need to be checked by the nurse in charge to analyse whether it is in normal range or not.
Since, the patients having diabetes includes higher tendency of urination than normal people and also the quantity of 800 to 2,000 millilitres in 24 hours can get enhanced or minimised. Other than this, the intake of water by the patient is also evaluated so as to maintain the balance within the body. So, that, the patient can remain in proper condition in order to act accurately to the medical treatments. In contrast, it can be stated that inaccurate observation of the urine outflow can prove disturbing and distressing for Brian as well as the nurse in the medication period (healthline.com, 2020).
Since, Brian comprises of both hypoxia and dyspnoea, therefore, laboured or improper breathing can result in Ketoacidosis. Other than this, as diabetes is a silent disorder, it can affect the function of the lungs and kidney thereby restricting the proper intake of breathing. Due to the presence of such types of symptoms, Dyspnea occurs, or is witnessed in Brian. As per the isobar technique, identification of the situation results in presentation of proper medicines such as Bronchodilators so as to make the process of breathing easier.
At the same, after observing the background, Brian can be offered with antianxiety medicines so as to minimise the range of panic of breathing. This can improve the health condition of Brian since, it is prime duty of a nurse as compared to many others. Considering the background history of Brian, steroids can also be provided to minimise the level of swelling of the lungs due to presence of Dyspnea. Doing so, can be useful for Brian as it could reduce the breathing problems and anxiety. This could enhance the living ratio of Brian considerably.
Since Brian has Hypoxia, which is another troubling disorder, so medicines need to be presented after proper observation. Since, numerous common symptoms of Hypoxia can be observed within Brian such as lack of energy to move effectively, impaired breathing rate as well as rapid breathing etc. Moreover, blood pressure of Brian is currently showing 120/75, which is also quite disturbing. Other than this, the conditions of Dyspnea also need to be checked from time to time so as to reduce its impacts over the body.
Only then, the oedema witnessed near the lower legs can be reduced to a considerable rate. Since it is a such a condition that results due to many causes such as congestive heart failure, kidney disorder etc. But in case of Brian, kidney disease is one of the prime causes that leaded to the swelling of Oedema in the legs. Therefore, the nurse needs to check the diabetes level as mentioned in history and to do so, the diet need to be made entirely sugar free. Also, the BPM rate need to be evaluated so that the breathing problems do not get increased. If such takes place, then the kidney could get damaged more and this can lead to increase in the breathing problem.
Diet checking is essential at this time, as it results in intake of salty foods and fluid. Along with this sitting in a single mode of position is also one of the prime causes of swelling in different parts of the body. And the underlining cause behind this is the poor circulation of blood in the entire body as well as presence of disturbed kidney. Coronary disorders are also equally responsible for oedema. Therefore, the nurse needs to be careful as the diet which is low in rate of sodium intake and the fluids can be taken maximum of 200Mls /day so that the blood circulation improves. Additionally, the insulin percentage also need to be noted from time to time as it is a hormone secreted by pancreas. And it helps to absorb sugar but it insulin is not used accurately, then it can result in accumulation of high glucose within the tissues of the body.
As a result, the lining of blood vessels can get damage and similar condition is viewed in Brian and so the blood circulation rate lowered effectively. Therefore, due to lack of blood circulation, the fluid got trapped within the legs of Brian and Oedema caused. Therefore, compression socks need to be presented to Brian so as to maintain exact quantity of pressure on legs and blood circulation improves. Elevation of the feet or exercise is another way that need to be made by the nurse so as to reduce the fluid retention in legs of Brian. Proper exercise in regular times also need to be performed by the nurse as a course of action to improve the condition of Brian. Weight need to be lowered so that swelling minimises and Brian gets better effectually.
Less intake of salt is another action that need to be maintained by nurse so as to amplify the condition of Brian. Magnesium supplements need to be added in food products by nurse in the hospital so as to regulate the function of nerves. By doing so, the rate of swelling can be easily restricted and Brian could be discharged from the hospital (diabetes.co.uk, 2020).
Another condition that need to be taken into action is tachyphoea or high respiratory rate. Brian also had this symptom, while getting admitted in the hospital. Such types of conditions occur mainly due to asthma or diabetes and Brian had high diabetes rate. Due to this, the rate of breathing of Brian is quite shallow. The cause behind this is due to presence high carbon dioxide in the body and lack of oxygen.
In the clinical settings, the medication for symptomatic treatment of heart failure are prescribed by the physician. The nurse's job is to administer medication as described. However, it is expected that nurses will be aware of the side effects of these drugs in pharmacological treatment and to ensure the progress of patients and prevent treatment-related complications. Careful treatment of heart disease can have serious side effects. The nurse will be responsible for the role of nursing in the administration of prescribed medications (Damy et al. 2018).
In this case, the nurse's intervention for a clinical nursing care plan for patients with heart disease should include, among others, monitoring of important priorities, changes in the patient's lifestyle, changes in patients' diets, administration of treatment and oxygen therapy, family and diagnostic tests. All of these interventions should be based on applicable treatment principles.
Low cardiac output features an important symptom of left heart failure. Therefore, nurses should be aware of the emergency symptoms, reduce the likelihood of change, record, adjust the nurse’s care plan, and report negligence to the physician. The status of important patient symptoms described in the next session informs the combination of nurse intervention and treatment by the physician.
Pulse pattern: Cardiac output and hypoxia are more likely to be pulse as a compensatory measure. Volume (pulse pressure) should be low as cardiac output is low. In addition, the patient presents with arrhythmia, indicating unprotected cardiac output (practicaldiabetes.com, 2020).
Blood pressure: Blood pressure is usually abnormal. Although systolic pressure is characterized as lower than normal, diastolic pressure can be neglected - it affects blood circulation because it weakens the arteries resulting in a weakened heart.
Saturation: The patient's illness may be less than normal, such as less than 90%, followed by low cardiac output with oxygen supply and lung congestion in chest heart failure.
Prediction: Breathing may be quick to compensate for hypoxia, but it is shallow because the body is not energy efficient.
Diet plays an important role in maintaining the health of patients with heart failure. Patients need to change their diet to follow the general fat-free formula. Thus, patients should be given a salt-free and fat-free diet while in the hospital. Salt-free diets reduce the risk of fluid retention, which can lead to heart disease, and fat-free diets can reduce the risk of ischemic heart disease. These foods should be well prepared to reduce the effort for mechanical digestion of solid foods, which creates energy needs, but in the case of dangerous patients of the body. It is better to serve small meals. Great food puts pressure on the heart, resulting in increased work pressure to reduce increased heart pressure, patients should be advised to maintain a half-baked position after each meal. Energy as a supplement should be supplied with calorie rich foods. Patients should be given vitamin rich foods to improve immunity as the body has less immunity due to low metabolism (medicalnewstoday.com, 2020).
The primary goal of early treatment of acute CHF anxiety is to reduce CHF symptoms, thus improving quality of life and stopping the progression of heart failure to reduce mortality., common causes of CHF loss include omission of dietary restrictions; Infection process, significant lung infection; And it reduces inappropriate therapy. Many of these changes occur and are prevented, meaning readers can avoid them. Various steps should be considered before removing patients admitted for CHF stimulation. Finding out when acute symptoms are decisive is important in determining a patient’s readiness to be excluded.
Physicians, when addressing causes of concern, should consider the patient's activity level, dietary habits, and weight monitoring. Patients should be advised to smoke. A complete review of partial changes should be made with the patient, who must make a complete demonstration before removal. Physicians should describe the warning signs and symptoms of anxiety and provide clear instructions on how to respond. Nurse should work to ensure that outpatient care is complete, not limited to social support, access to leave, and the assurance of an appointment with primary care 7 to 10 days after discharge. Some patients who do not agree with the text predictive medication (Halaw, et al. 2018).
Damy, T., Isnard, R., Salvat, M., Tribouilloy, C., Picard, F., Eicher, J., ... & Berthelot, E. (2018). Prevalence and determinants of pulmonary arterial hypertension (PAH) in acute and chronic heart failure (CHF). FRESH study from GICC. Archives of Cardiovascular Diseases Supplements, 10(1), 31.
diabetes.co.uk (2020), from: https://www.diabetes.co.uk/diabetes-complications/edema-and-diabetes.html [accessed on 02/05/2020].
Halawa, A., Burton, M. C., Maniaci, M. J., Shapiro, B. P., Yip, D. S., Hodge, D. O., ... & Dawson, N. (2018). Association of Anemia with Outcomes of Acute Heart Failure. Southern medical journal, 111(2), 103-108.
healthline.com (2020), from: https://www.healthline.com/health/diabetes/diabetes-swollen-feet#try-essential-oils [accessed on 02/05/2020].
medicalnewstoday.com (2020), from: https://www.medicalnewstoday.com/articles/324548 [accessed on 02/05/2020].
practicaldiabetes.com (2020), from: https://www.practicaldiabetes.com/article/lower-limb-oedema-diabetes/ [accessed on 02/05/2020].
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