Analysis of a Cardiovascular Case Scenario
- Careful monitoring of factors such as weight, fluid intake, electrolytes and renal functions
- Careful scrutiny for renal dysfunction development
- Fluids and sodium restriction,
- Administration of a raised dosage of loop diuretics either orally or intravenously
- Administration of supplemental oxygen
- Positive pressure ventilation that is non-invasive
- Intravenous vasodilators
- Additional drug therapy , for instance the adminsartion of beta blockers, ACE inhibitors, amongst others
Rationale for the Administration of Medications
IV furosemide (Lasix) - This is a loop diuretic that inhibits the sodium and chloride ions and water absorption in the nephron’s convoluted tube as well as the loop of Henle. The overall result is that the absorption of water is decreased while the production of urine is increased. In addition, the intravascular volume is decreased.
Enalapril (Vasotec) - This ACE inhibitor blocks the enzyme that is responsible for the creation of angiotensin II. This results in lowered blood pressure.
Metoprolol (Lopressor) - This is classified under beta blockers. The rationale behind the use of this drug is that it inhibits the strength or tenacity of the contractions of the heart. In addition, it regulates the heart rate. This leads to a significant decrease in the cardiac oxygen consumption.
IV morphine sulphate (Morphine) - This is an opiate agonist that binds with the opioid receptors. Morphine actually reduces hypertension in two ways: the release of histamine and the depression of the vasomotor brain centers. Morphine reduces the sympathic nervous system stimulation that is caused by anxiety and pain. The reduction of this stimulation reduces the cardiac work, the heart rate as well as myocardial oxygen consumption.
Conditions That Cause Heart Failure
Coronary artery disease
This is a disease that affects the arteries that supply oxygen and blood to the heart. It causes a decreased flow of blood to the heart. If the arteries become severely narrowed or blocked, the heart is starved for nutrients and oxygen. To prevent the occurrence of this disease and thus avert one from the consequences of heart failure, the nurse should intervene and advise the patient on how to lead a healthy lifestyle that incorporates weight management, good nutrition and regular physical activity.
Heart Attack
This occurs when a blockage of a coronary artery occurs suddenly therefore stopping blood flow to the heart. A heart attack essentially injures the heart muscle which results in scarred part that does not function effectively. Nursing interventions that can help to alleviate the adverse effects of this condition include encouraging patients to do away with destructive behaviors such as smoking and obsessive eating.
Cardiomyopathy
This is damage to the heart that is caused by factors such as drug abuse, alcoholism or heart infections. The most plausible intervention is the discontinuation of drugs and alcohol ingestion.
High blood pressure
This is a cardiovascular disorder where blood pressure becomes abnormally high (above 140/90 mmHg). To prevent this condition from leading to heart failure, nursing interventions such as blood pressure monitoring and medication therapy should be initiated.
Preventing the problems resulting from multiple drug interactions in older patients
Interventions
Information- Involves keeping accurate lists of all drugs or medications including dosages, brand names and reasons for taking the medication. The rationale behind this is that it eliminates drug confusion and enables patients to keep track of the medicines they are taking and their correct dosages.
Instruction- This should be accompanied by good communication skills and techniques. This intervention technique involves instructing the patients on various matters such as when to start taking or when to stop taking medication. This ensures that all the schedules of drug ingestions are adhered to and the patients take drugs according to their specifications.
Organization- This involves a variety of activities such as cautioning patients to only take drugs recommended to them, how to store their medicines amongst others. This intervention also eliminates confusion and ensures that patients are only taking the drugs prescribed to them and that they are doing it in a correct manner.
Matching the medication routine to the patients goals of care and current condition-This is where the nurse performs a careful consideration of the medicines that should be substituted or discontinued all together. The rationale for this is that it reduces the large medicine load that may lead to problems when the medicines interact. It does this by removing irrelevant medications or those that are no longer needed form the regimen.
References
Genest, J. (2000). Hypertension, physiopathology and treatment. New York: McGraw-Hill.
Holland, J. M. (2001). Cardiovascular nursing: Prevention, intervention, and rehabilitation. Boston: Little, Brown.
