Nursing interventions that would be appropriate for Ms J during her admission to the ICU would include the following:
- Continuous monitoring of VS and oxygen saturation after nasal O2 is applied – if saturations do not improve change to mask and do not rule out possible intubation – elevate HOB to a semi-fowlers position to facilitate easier effort of breathing
- Assess for changes in her alertness or signs of confusion or hypoxia
- Observe rhythm for increased ventricular rate with atrial fib and deterioration in cardiac status with ectopy or onset of chest pain
- Provide an environment that allows for rest and decreased anxiety – organize nursing care to facilitate rest periods
- Monitor intake and output for cardiac stability as well as dehydration from the onset of the flu
- Auscultate chest more frequently for breath sounds to determine improvement or deterioration in status
- Administer medications as ordered and assess for prn meds to facilitate reduction in fever, generalized achiness from flu, decrease anxiety and promote rest
Rationale for the following meds (“Heart Failure Treatments and Drugs”, 2017):
- LASIX IV – Produces diuresis in the kidneys and dilation in the venous system to promote a preload reducing effect that is seen within minutes once administered. Promotes excretion of water from the body and decreases fluid in the lungs to improve breathing
- VASOTEC – an Angiotensin-Converting Enzyme (ACE) inhibitor is a vasodilator that increases the blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart.
- LOPRESSOR – A beta blocker that reduces the symptoms of oxygen demand and myocardial ischemia of heart failure, improves the pumping action, and lowers the heart rate and blood pressure. Also increases diastolic relaxation to allow for the heart to fill properly due to wall motion stiffness.
- MORPHINE IV – Induces vasodilation and increases venous return to the heart, acts as a mild arterial dilator, decreases myocardial oxygen consumption, centrally suppresses symptoms of breathlessness, decreases anxiety and reduces pain.
Four CV conditions that may lead to heart failure; what medical/nursing interventions can prevent the development of heart failure in each condition:
- Coronary Artery Disease/and MI is the most common cause of heart failure in which the arteries to the heart that supplies blood become narrowed or blocked. When blood flow is completely blocked the heart muscle suffers damage and blood supply is reduced and the area around the muscle and blockage dies or suffers loss of blood flow. If the damage affects the pumping ability, heart failure develops. Preventative measures to avoid CAD/MI are the lifestyle changes that slow the progression of atherosclerosis or avoided – patient teaching and education regarding a balance diet, exercise, smoking cessation, controlling BP and cholesterol levels. Patients that have developed CAD should consider the regime of taking an ASA daily, beta blockers to reduce the workload of the heart, routine follow-ups with MD to prevent further advancement of heart failure. Proactive with testing for cardiac catheterization for stent placement and evaluation of coronaries/heart function (Copstead& Banasik, 2012).
- Cardiomyopathy is a general term describing disease of the heart muscle.