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

Getting orders to stabilize MRS. J is priority.

According to ABCs. Putting oxygen on (Mrs. J's O2 sats are 82%).

Keeping head up to prevent aspiration. Mrs. J is coughing frothy blood-tinged sputum. Additionaly, she has pulmonary cracles and decreased lung sounds.

Decrease anxiety and respiratory rate.

Monitor vital signs and heart function closely.

Administer medications as ordered.

Weight, strict I&O's and fluid restriction. Mrs J. is retaining fluid. As nurses we need to know she is producing urine and measure her kidney function as well.

Monitor labs (electrolytes, kidney function, liver function).

Follow up on hepatomegaly.

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

Lasix - According to American Heart Association when "the heart does not circulate blood normally, the kidneys receive less blood and filter less fluid out of the circulation into the urine.

The extra fluid in the circulation builds up in the lungs, the liver, around the eyes, and sometimes in the legs (American Heart Association, 2017).

Since edema and crackles in the lungs were noted patient should be started on diuretics to get rid of the extra fluid in the body.

Vasotec - is angiotensin converting enzyme (ACE) inhibitor class of medication. By blocking this enzyme it lets vessels to relax and pump more blood, more efficiently into the body (Mayo Clinic, 2017).

Metoprolol - is a beta blocker. Beta blockers prevent norepinephrine (adrenalin) from acting on beta receptors in blood vessels and in the heart. This causes blood vessels to relax. By relaxing the vessels, beta blockers help to lower blood pressure and reduce chest pain (Mayo Clinic, 2017). Metoprolol tends to lower heart rate and is used for arrhythmias.

Additionally, blood pressure medications will help control the blood pressure, reduce the cardiac workload and increase the supply of blood and oxygen to the heart (American Heart Association, 2017).
IV morphine sulphate- is an opiod. Usually indicator for its use is a pain. However it works for brain respiratory center, lowering breathing rate and anxiety.

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

According to Mayo Clinic the best way to prevent heart failure is to control risk factors such as obesity, coronary artery disease, high blood pressure, high cholesterol and diabetes (2017) .

Coronary artery disease - with certain risk factors overtime blood flow in vessels becomes restricted because of plaque buildup.

Compromised blood flow depletes heart of oxygen and nutrients leading to weakening of the heart muscle and congestive heart failure. Heart is not able to pump efficiently enough to meet body's needs. Body starts to retain fluid and that is called "congestion" (Mayo Clinic, 2017).

Interventions: getting heart educator to talk to the patient, nutrition consult. Making sure patient understands medications purpose, schedule and taking them as prescribed. Assessing patient's home situation to make sure Mrs J. has appropriate living conditions to be able to follow diet, medication plan and dr's appointments.

High blood pressure - according to American Heart Association (AHA) HTN is when force of the blood flowing through blood vessels is constantly too high (AHA, 2017).

Interventions: part of a heart education would be ways to control blood pressure (measuring it every day, diet, follow up appointments with cardiologist). Smoking cessation program (support program will be needed since patient is not willing to quit)

Obesity - obesity puts stress on entire body including cardiac system. Heart has to work harder to pump blood. According to American College of Cardiology (AAC) left ventricular hypertrophy is very common in people who are obese (2015).

Interventions: Nutrition consult, patient needs encouragement and support to be able to implement changes of her habits. Working with patient, finding support programs for mental and physical support. In Mrs J.'s case weight loss could help with her sleep apnea as well.

High cholesterol - too much cholesterol in the blood causes build up on the walls of the arteries. Overtime blood flow gets compromised and might lead to negative consequences like heart disease, blood clots, high blood pressure etc (AHA, 2017).

Interventions: Nutrition consult (education about right food choices is crucial), follow up labs measuring LDL and LHL. Take medications as prescribed.

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.

Make sure medication reconciliation is complete and accurate. Having complete list of medications that patient is taking at home is the base for physicians to see if anything needs to be adjusted.

Assessing patient's compliance. Mrs J. on admission admitted that she did not take her medications for the last four days. In her condition compliance will be extremely important. Knowing patient compliance nurse can create appropriate education plan.

Medication education. Education about patient's medications including purpose, doses, frequency etc. Additionally, it will be important to discuss which medication to take at what time of the day and indicating if it is taken with, before or after meal.

Assessing patient's home situation. Understanding if patient is able to fill out her prescriptions and monitor her own, correct medication intake. Possibly, home health for cardiac assessment will be needed.

References:

American College of Cardiology. (2015). The Obesity Paradox in Heart Failure: Why Does It Clinically Matter?