- What nursing diagnosis is most appropriate for this patient?
Heart failure
- The nurse obtains laboratory results from tests drawn on admission including BNP 1275 pg/mL, K 5.4 mEq/L, creatinine 2.7 mg/dL, BUN 42 mg/dL. The nurse contacts the prescriber who orders a stat electrocardiogram, which shows S-T changes. What action should the nurse take at this point?
The nurse should immediately transfer the patient to the coronary care unit and the necessary emergency drugs to control the high blood pressure given first.
- The patient is transferred to the coronary care unit. Oxygen is administered along with furosemide (Lasix), morphine, nitroglycerine, and enalipril (Vasotec). What is the rationale for administration of these drugs?
Oxygen is provided since blood is not circulating as expected due to the heart failure. Heart failure indicates less blood being pumped to perfuse various organs. Hence to avoid damage to vital structure like the brain, heart and lungs, oxygen is provided. In addition, in heart failure, there is a tendency for such patients to develop breathing problems associated with cor-pulmonale. Furosemide is given since it is a loop directing and first line to reduce hypertension and minimize on oedema in a heart failure patient. Nitroglycerine is a good dilator and aims to increase blood flow to the heart especially coronary arteries so as to reduce heart’s work load. Morphine in this case was used as a pain reliever as well as a preventive measure to reduce instances of sleep apnea experienced by the old man. It also got the ability to cause vasodilatation of leg vessels. Enalipril was generally used for the purpose of lowering the high blood pressure of the patients.
- The patient is stabilized and is transferred to the nursing unit. Prescribed drugs include carvedilol, enalipril, and furosimide. What laboratory values does the nurse need to monitor when a patient is receiving these drugs?
Patient should constantly be monitored for potassium levels and calcium levels
- What teaching should the nurse provide to prepare this patient for discharge?
The nurse should provide the patient with education regarding the importance of taking those drugs. In addition, education regarding time to be taken, how to be taken, and side effects should also be mentioned to the patient. Furthermore, constant home monitoring of sugar levels plus blood pressure levels should be advised and informed to visit the doctor when they become uncontrolled. Furthermore, the patients should also be educated on the importance of taking diabetes drugs and proper nutrition with emphasis on avoiding foods with salts. Moreover, the patient should be encouraged to avoid strenuous activities that may overwork his heart.
- The patient lives in an apartment building with 12 stairs to climb to his apartment. After climbing the stairs, he needs to rest because he is short of breath. He can, however, perform most activities of daily living. According to the New York Heart Association (NYHA), what is this patients HF classification?
