Rationale for Congestive Heart Failure Nursing Interventions
Hi here is the CLC Assignment . Based on patient health history and discharge orders, 4 of the problems (in page 2) and interventions identified . Pls provide rationale for the interventions in details. I have added Patient history and Discharge order for the patient.
Sallie Mae Fisher’s Health History
and Discharge Orders
Sallie Mae Fisher Health History
Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. During the last 6 months, she has been hospitalized four times for exacerbation of her CHF. She was discharged home last Saturday from the hospital after a 3-day stay to treat increased dyspnea, an 8-pound weight gain, and chest pain.
Ms. Fisher is recently widowed and lives alone. She has a daughter, Thelma Jean, who lives in town but works full time and has family issues of her own. Therefore, family support is limited.
Hospital Discharge Instructions
- Mountain Top Home Health to evaluate cardio-pulmonary status, medication management, and home safety.
- Medical Equipment Company to deliver oxygen concentrator and instruct patient in use. O2 at 2 liters per nasal prongs PRN.
- Prescriptions given at discharge:
- Digoxin 0.25 mg once a day
- Lasix 80 mg twice a day
- Calan 240 mg once a day
- Order written to continue other home meds.
Assignment: Provides rational for interventions identified. Discussion of rationale includes support from outside resources (current evidence-based literature).
Nursing Interventions for Problems Identified
1. Medication Intervention: Provide a written schedule for taking medication as well as a pillbox that can be filled weekly by home health nurse. Call primary MD to clarify Lasix and Digoxin for duplicate therapy. Schedule one nurse visit with patient just to talk about medication. Teach patient with the teach-back method to reinforce importance of taking medication correctly. Identify parameters for certain medications and how to monitor at home (ex-hold Digoxin for pulse <60)
2. Depression/Lonliness: provide emotional support to patient and validate her feelings. Provide resources for social support and activity (ex-senior center, adult programs, bingo) Provide resources on transportation to these activities and events if patient unable to drive. Many adult day programs will pick up members at their home and transport them to and from the day program. Assist patient in becoming a part of these programs if she is interested. Monitor emotional status from week to week, perform a suicide assessment, and keep in contact with primary MD to initiate an antidepressant if needed.
3. Safety Intervention: The key intervention in regards to safety is education. Encourage patient to remove throw rugs or clutter to prevent a fall. Many times patients will modify their homes if education is given on falls and the aftermath of a fall. Encourage personal safety and locking the door. Provide a lock box to hang on the door that the nurse has the code to- to enter the apartment in the event of an emergency. Provide education and information on the use of a life alert or other call device. These can be programmed to call 911 a family member, or the home health agency. Educate on the benefits of oxygen support and how this can make the patient feel better and have an improved quality of life. Educate and encourage patient to report any new symptoms, problems (such as nausea, constipation) to her nurse to help manage symptoms. In addition, educate to report all new medications to the nurse as well.
4. Nutrition Intervention: Provide education on why proper nutrition and hydration is so important, especially with taking medication. Provide a jug or thermos that patient can use to ensure she is taking in enough fluid during the day (but not too much!) and monitor I&O. Assist patient with signing up for meal delivery program (ex-Meals on Wheels) that will deliver a hot meal to the patient every day of the week. Educate on daily weights and help patient keep a log near the scale to record her weights.
Rationale for Congestive Heart Failure Nursing Interventions
Congestive heart failure (CHF) is a medical syndrome associated with the constellation of symptoms that present from hypoperfused tissues and congested organs (Weber, 2004). Its manifestation is attributed to a salt-avid condition involving Na+ retention (like urinary K+/Na+ < 1.0) which is based on the activation of circulating renin-angiotensin-aldosterone system (RAAS), that has an effector hormone which overwhelms the effective performance of natriuretic peptides (Weber, 2004). This essay will provide a rationale on nursing interventions for Sallie Mae Fisher's health condition (aged 82). She suffers from CHF, atrial fibrillation, and hypertension, which have prompted her to be hospitalized four times due to exacerbation of her CHF. Nevertheless, she has been discharged and the interventions have been put in place to help her manage her health condition.
Ms. Fisher needs urgent medical care not only because of her age but also because of the myriad of life threatening illnesses she is suffering from. For instance, atrial fibrillation is a chronic heart rhythm disturbance that has been associated with thwarting the quality of life for about 4% of aged populations (Shea & Sears, 2008). According to study, the chronic heart rhythm disturbance heightens the vulnerabilities of stroke (Shea & Sears, 2008). Clinical evidence points outs out an unequivocal correlation between atrial fibrillation and hypertension (Prystowsky et al, 1996). Furthermore, Prystowsky et al, (1996) notes that most patients, especially elderly people, experience dyspnea, dizziness and fatigue. In order to manage all these conditions, reliable medical attention is necessary. As a result, through nursing interventions, Ms. Fisher has access to health care.
Some of the medicines prescribed to Ms. Fisher included Digoxin 0.25 mg which is be taken daily. In addition, Ms. Fisher could call primary MD incase she needed clarification on Lasix and Digoxin for duplicate therapy. Digoxin is a positive inotropic agent that influences neurohormonal modulation (Packer, 1993). According to clinical studies, the effects of neurohormonal modulatory are experienced when a patient is under low doses of digoxin (less than 0.25 mg per day) (Campbell & MacDonald, 2003) consequently, because of her age and sedentary life, the hospital scheduled a regular one nurse visit to her home to talk about medication and the importance of taking them according to [prescribed] dosage and schedule. For instance, Digoxin plays an important role when prescribed in the combination of other agents like verapamil, β-blockers or diltiazem, in achieving better resting ventricular rate management for patient suffering from chronic atrial fibrillation, [like Ms. Fisher] (Campbell & MacDonald, 2003).
The nutrition intervention is crucial in Ms. Fisher's case to provide her with education on why proper nutrition is so important. Research has pointed out that, patients suffering from chronic heart failure show symptoms that are likely to adversely impact their food intake (Jacobsson, Pihl-Lindgren & Fridlund, 2001). Some of these symptoms include tiredness, breathing problems and gastrointestinal signs like loss of appetite, nausea and ascites. On the other hand, Pharmacological therapy (induced through medical interventions) results to declined appetite hence negatively impacting food intake, which in turn inhibits required nutritional needs and energy (Jacobsson, Pihl-Lindgren & Fridlund, 2001). As part of the nutrition intervention, Ms. Fisher was given a thermos to ensure she is taking enough fluid during the day (but not too much). This was necessary because research has identified that patients suffering from chronic heart failure have hypermetabolism as well as, and this condition leads to forced diuresis (Georges & Stotts, 1985). On the other hand, Freeman and Roubenoff (1994) note that, small but regular foods or continuous nutritious foods are preferred for CHF patients. As a result, the nutrition intervention helps patients in signing up for meal delivery program that will deliver a hot meal to the patient every day of the week. This will help her to have a variety of appetizing foods (Jacobsson, Pihl-Lindgren & Fridlund, 2001). Most importantly, patients like Ms. Fisher are educated on how to manage their condition, especially their weight because it is important for them to feel that they are in control of their situation (Jacobsson, Pihl-Lindgren & Fridlund, 2001).
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