This patient has received IV furosemide because her heart failure has lead to pulmonary edema, as is evident by the presence of pulmonary crackles. Furosemide is a powerful diuretic. This medication is also good for the treatment of her hypertension. Enalapril is an ACE (angiotensin converting enzyme) inhibitor that is used for the treatment of hypertension and some forms of heart failure. Enalapril has been shown to lower mortality in patients with systolic heart failure, which is most likely what this patient is suffering from considering her chronic history of hypertension. Metoprolol is used because this patient has ventricular tachycardia given that her ventricular rate is 132 bpm. Metoprolol can also be used for the treatment of heart failure as well as hypertension. This patient is also very nervous given that she asked the nurses and doctors if she is going to die and obviously is very anxious. Metoprolol is also prescribed off label for the treatment of anxiety. Morphine sulfate is given to this patient because morphine is indicated for patients with dyspnea associated with left ventricular dysfunction and pulmonary edema.
Hypertension leads to the development of heart failure, as the heart is required to pump against an ever-increasing pressure. In the beginning the heart enlarges to compensate for the increase in pressure but overall this is a maladaptive process, as the heart cannot keep up with this increasing requirement (Harrison’s, 2008). To deal with this problem, nurses and doctors can use many methods to treat the hypertension. The use of diuretics and ACE inhibitors as medication is beneficial. ACE inhibitors prevent the reabsorption of sodium and water leading to decreases in blood pressure. Along with this effect, ACE inhibitors are also used to prevent remodeling of the heart (Vasan & Wilson, 2013).
Alcohol may lead to dilated cardiomyopathy. Patients should that are chronic alcohol abusers should be identified in clinical practice by the use of the CAGE questions. Patients that are positively identified, should be advised on the health hazards of alcohol and if need be, receive information regarding alcoholics anonymous and the possibility of speaking to a therapist (Harrison’s, 2008).
Coronary artery disease, whether it be myocardial ischemia or myocardial infarction can also lead to the development of CHF. Doctors and nurses should identify those patients that are at greatest risk for having a myocardial infarction. Risk factors include, smokers, patients with high triglycerides, patients with a history of hypertension, diabetic patients, and those with a family history. Some treatment options for these patients include, lifestyle modification, which includes a change in diet, exercise, and smoking habits. Pharmacology for these patients include beta-blockers, statins, and anti hypertensive medications (Vasan & Wilson, 2013).
Another form of heart failure can result from the development of Chagas disease. This is caused by a parastie, so patients should be advised when traveling to endemic countries.
Older patients receiving polypharmacology should be advised by nurses to keep a running list of their drugs and the dosages on a piece of paper and to keep up with compliance of their medication. Patients should also notify doctors immediately case of the development of any adverse effect. Other methods of reducing the confusion associated with polypharmacology include, limiting the number of pharmacies, making sure their medical files are up to date, and above all review the warning labels on each drug.
Works Cited
Braunwald E., Fauci, S., Hauser S., Jameson J. Kasper D., Longo D., Loscalso J. (Eds.). (2008). Harrison’s Principles of Internal Medicine (17th edition) New York. McGraw Hill Medical.
Vasan, R. & Wilson, P. (2013) Epidemiology and causes of heart failure. UpToDate. Waltham, MA. Retrieved from: http://www.uptodate.com/contents/epidemiology-and-causes-of-heart-failure?detectedLanguage=en&source=search_result&search=heart+failure&selectedTitle=8~150&provider=noProvider
