CAMILLE MACTAL NCMB314

BSN 3Y1-1 NOVEMBER 09, 2021

Unit Task: Cardiovascular Changes
Case Scenario:
Mr. H, an 82-year-old man who is widened and lives alone, arrives in the emergency room
complaining he has had difficulty breathing, especially at night, associated with nausea, for
the past week. He states that he must sleep with two pillows to breathe more easily at night and
still does not get a good night’s rest. He also complains of a cough that is worse at night and
relieved by nothing. Mr. H has pneumonia.
Assessment of Mr. H reveals the following;
Vital signs:
           temperature, 98F
           apical heart rate 86 beat s/min and irregular
           respiratory rate, 36 breaths/min and labored
           blood pressure, 170/96 mmHg
Skin – pale, cool, and diaphoresis
Inspiratory bibasilar crackles that do not clear with coughing
S3, heart sound on auscultation
Visible jugular vein distention
3+ bilateral pedal edema
A 12-lead ECG and a chest x-ray examination are ordered.
An intravenous line is started at a “keep vein oven” (KVO) rate.
Oxygen via mask
Admitted with a diagnosis of CHF.
1. What are the signs and symptoms of heart failure?
 Shortness of breath (dyspnea) when you exert yourself or when lying down
 Fatigue and weakness Swelling (edema) in legs, ankles and feet
 Rapid or irregular heartbeat Reduced ability to exercise
 Persistent cough or wheezing with white or pink blood-tinged phlegm
 Increased need to urinate at night
 Swelling of the abdomen (ascites)
 Very rapid weight gains from fluid retention
 Lack of appetite and nausea
 Difficulty concentrating or decreased alertness
 Sudden, severe shortness of breath and coughing up pink, foamy mucus
  Chest pain if heart failure is caused by a heart attack

2. Give 7 lifestyle modifications to teach older adults with heart failure and discuss briefly.
 Quit smoking and drinking.
 Dietary changes.
 Limit fats and cholesterol
 Monitor salt and fluid intake.
 Lose excess weight.
 Exercise regularly
 Maintain normal blood pressure.
 Take medications as prescribed.

3. Make a drug study on Digoxin including the nursing consideration.

NAME ACTION INDICATION CONTRAINDICATIONS SIDE EFFECT NURSING

RESPONSIBILITIES
Generic Name: Increases the Heart failure. Contraindicated in: CNS: Fatigue, Monitor ECG during IV
Digoxin force of Hypersensitivity headache,
myocardial Atrial Fibrillation and weaknesses. Administration and 6 hr. after each
Therapeutic contraction. atrial flutter (slows Uncontrolled ventricular dose. Notify health care professional if
Class: ventricular rate) arrhythmias; AV block (in CV: ARRHYTMIAS bradycardia or new arrhythmias occur.
Antiarrhythmic Prolongs absence of pacemaker) Bradycardia, ECG
refractory period Paroxysmal atrial changes, AV block, Observe for signs and symptoms of
Pharmacologic of the AV node. tachycardia Idiopathic hypertrophic sub aortic SA block toxicity. In adults and older children,
Class: stenosis first symptoms of toxicity usually
Decreases EENT: blurred vision, include abdominal pain, anorexia,
Digitalis conduction Constrictive pericarditis: tallow or green vision nausea, vomiting, visual disturbances,
glycosides through the SA bradycardia, and other arrhythmias
and AV node GI: anorexia, nausea
Known alcohol intolerance (elixir
Dose; only) and vomiting, diarrhea If signs of toxicity occur and are not
PO Geriatrics Therapeutic severe. discontinuation of digoxin may
Patient: Effects Hemat: be all that is required.
Initially daily Increased thrombocytopenia
dose should not cardiac output Do not confuse Lanoxin (digoxin) with
exceed 0.125 (positive inotropic levothyroxine or naloxone.
mg effect) and Metabolic: electrolyte
slowing of the imbalances with acute
heart rate digoxin toxicity
(negative
chronotropic
effect).

4. Give 6 objectives with interventions (for each objective) in the management of CHF.

 Patient will report decreased episodes of dyspnea, angina: Teach patient relaxation
techniques and how to use them to reduce stress. Administer morphine sulfate.
 Patient will participate in activities that reduce cardiac workload. Implement graded
cardiac rehabilitation program. Adjust client's daily activities and reduce intensity of level.
Discontinue activities that cause undesired psychological changes
 Demonstrate stabilized fluid volume with balanced intake and output, breath sounds
clear/clearing, vital signs within acceptable range, stable weight, and absence of
edema.: Follow low-sodium diet and/or fluid restriction. Administer diuretics as
prescribed.
 Change position frequently. Elevate feet when sitting. Inspect skin surface, keep dry,
and provide padding as indicated.
 Increase in cardiac output: Administer medications as prescribed: Digoxin, ACE
inhibitors, vasodilators, diuretics Patient's respiratory pattern will be effective without
causing fatigue : Position patient in optimal body alignment in semi- fowler's position for
breathing and Assist patient to use relaxation techniques
 Patient will Identify own stress/risk factors and some techniques for handling. Explain
and discuss patient's role in control of risk factors (smoking, unhealthy diet) and
precipitating or aggravating factors (high-salt diet, inactivity, overexertion, exposure to
extremes in temperature). And also encourage developing a regular home exercise
program, and provide guidelines for sexual activity.