Critical Thinking in a nursing situation
Introduction
Acute decompensated heart failure is a medical emergency; the nurse should, therefore, take the immediate necessary action to save the patient’s life. This paper will critically analyze the appropriate measures to manage Mrs. J a chronic failure patient who has been diagnosed with acute decompensated heart failure.
Nursing interventions
The nurse should administer oxygen at 8L/min or a higher concentration to the patient. The oxygen therapy will relieve the dyspnoea and the hypoxia that Mrs. J is experiencing. The nurse should further take interventions aimed at reducing the venous return to the heart of Mrs. J. the nurse should put Mrs. J in an upright position; her shoulders and head should be up, her legs and feet should face downwards. Such a position will promote pooling of blood in the dependent parts of the patient’s body by force of gravity, in turn, reducing the venous return (Ponikowski et al., 2016). The nurse could further administer prescribed medication like diuretics, vasodilators, and cardiac glycosides.
Rationale for drug therapy
Intravenous furosemide is a diuretic; it is administered to Mrs. J to enhance excretion of water and sodium from the body through the kidneys. Furosemide will, therefore, achieve a rapid diuretic effect. The IV furosemide will further vasodilate the peripheral blood vessels and cause blood to pool in the peripheral blood vessels subsequently reducing the venous return to the heart. Enalapril is an Angiotensin Converting Enzyme Inhibitor ACE-Inhibitor; the rationale is to lower the afterload of the left ventricle (Ponikowski et al., 2016). The heart rate will subsequently be decreased due to Mrs. J’s chronic heart failure; the CO of the heart and the workload will be reduced. Metoprolol is a Beta-adrenergic blocker; it is administered to lower the workload of the heart. It also protects against fatal dysrhythmias. Finally, IV morphine is administered to decrease the peripheral resistance and the venous return to the heart. This is to enable the redistribution of blood to the rest of the body from the pulmonary circulation (Ponikowski et al., 2016). The whole process lowers the pressure in the pulmonary capillaries and lower seeping of fluid into the tissues of the lungs. The morphine will also be helpful in reducing Mrs. J’s anxiety.
Contributing morbidities
Coronary Artery Disease (CAD) has been noted to be the primary cause of heart failure in the majority of the cases. Ischemia leads to heart failure because of the resultant acidosis due to excess lactic acid and hypoxia.CAD can be medically managed by revascularization of the coronary artery through percutaneous coronary intervention. Cardiomyopathy is another condition that can contribute to chronic heart failure. Cardiomyopathy can reduce the distensibility and ventricular filling thus causing heart failure. Cardiomyopathy can be managed by surgical placement of stents (Ramani, Uber, & Mehra, 2010). Hypertension is another condition that can lead to chronic heart failure.
Hypertension can be medically managed using pharmacologic agents like beta-adrenergic blockers, and vasodilators like hydralazine. Hypertension increases the work of the heart pumping blood to the body thus leading to heart failure. Diabetes mellitus is the other condition that can cause heart failure. Diabetes mellitus complicates to damage of the blood vessels and nephropathy (Ramani, Uber, & Mehra, 2010). Collectively these lead to heart failure. Diabetes mellitus can be managed using insulin therapy and diet modifications.
In conclusion, heart failure is a chronic ailment that needs careful management. This paper has described the nursing interventions necessary for Mrs. J in her acute decompensated heart failure. The paper has further explained the rationale for the prescribed medication and the contributing morbidities that could cause heart failure.
References
Arroll, B., Doughty, R., & Andersen, V. (2010). Investigation and management of congestive heart failure. BMJ, 341(jul14 2), c3657-c3657. http://dx.doi.org/10.1136/bmj.c3657
Ponikowski, P., Voors, A., Anker, S., Bueno, H., Cleland, J., & Coats, A. et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37(27), 2129-2200. http://dx.doi.org/10.1093/eurheartj/ehw128
Ramani, G., Uber, P., & Mehra, M. (2010). Chronic Heart Failure: Contemporary Diagnosis and Management. Mayo Clinic Proceedings, 85(2), 180-195. http://dx.doi.org/10.4065/mcp.2009.0494
