please read the peers discussions and respond to them APA format with reference

Discussion 1

Mrs. J. is already diagnosed with congestive heart failure, whichoccurs in association with other cardiac disorders from a number ofdifferent causes (Copstead & Banasik, 2012). Heart failure is theinability of the heart to maintain sufficient cardiac output tooptimally meet metabolic demands of tissues and organs and thisresults in the end stage of most cardiac diseases.

Nursing interventions that are appropriate to Mrs. J. at the time ofadmission. Considering the clinical manifestations that this patientis presenting with, she is quite sick and the first issue to beaddressed is her airway and oxygenation saturation to ensure that sheis receiving enough oxygen to the brain and all other parts of thebody. She will need to be placed in bed, made comfortable and givenreassurance because she is anxious, worried and asking whether she isgoing to die. Reassurance and company with a staff is important. Herrespiratory rate is rapid (34), Blood pressure is 90/58 so intravenousfluids will not be recommended because she has congestive heartfailure however, because she is also put on intravenousLasix, she may need limited intravenous fluids sparingly. She haspalpitations with a heart rate of 118. Mrs. J. will be placed ina room that is close to the nurses’ station and full of lightbecause she scared and will need to be watched closely.

Mrs. J. will need a 12 lead EKG after she has been placed in bed, IVaccess placed, full blood work chemistry and urine collected, a chestx-ray ordered because she is complaining of not getting enough air.Blood cultures will be collected for because she may be havinginfection as she Pharyngitis. She will also need Arterial blood gasanalysis to determine the oxygenation in her blood stream. She is alsoreported to be anxious, and morphine injection is ordered which helpsto calm her down and also helps decrease the heart demand foroxygen. Mrs. J. will need to be given supplementary oxygenbecause she is complaining of not getting enough air and reassurancecontinued. Gradually as her condition improves, education aboutsmoking will discussed as a way of helping towards improvement and maybe an alternative for smoking such as use of nicotine patch.

The rationale for giving intravenous furosemide (Lasix) is to helpin diuresis since she has fluid overload as evidenced by peripheraledema (1+). Enalapril (Vasotec) is given because it is an ACEinhibitor (angiotensin converting enzyme), which helps by blocking asubstance in the body that causes the blood vessels to tighten, and asa result, enalapril releases the blood vessels, which lowers the bloodpressure and increases the supply of blood and oxygen to the heart.Metoprolol is a beta-blocker that is given because it affects theheart and circulation and is used mostly in hypertensive patients andpatients with irregular heartbeats as already noted in Ms. J. With aventricular rate of 132 and arterial fibrillation. Morphineadministration decreases the hear demand for oxygen and also as asedative for the patient.

Four cardiovascular conditions that may lead to heart failure andwhat can be done in the form of medical/nursing interventions toprevent the development of heart failure in each condition. One of theconditions is Coronary heart disease which is a waxy substance calledplague that build inside the coronary arteries and it causes narrowingof the arteries (National Heart, Lung, and Blood Institute, n.d.) thusreducing the flow to the hear muscles and the build- up also makes itmore likely that blood clots in the arteries. This can beprevent by taking a healthy diet that low in cholesterol,exercising and also by having regular medical checkups and observingthe weight gain to ensure this is controlled.

Arrhythmias occurs when there change of the heart rates or rhythm ofthe heart and can be due to some beverages like caffeine and drugslike cocaine, amphetamines and marijuana. Education to those who areprone or predisposed to those drugs is the nursing intervention andcreating awareness and effects of those substances.

Myocarditis which is the inflammation of the heart muscles canresult from infections such as sore throat and other infections.Nursing education for effective treatment and taking of antibiotics isimportant and those that fall sick need to seek medical attention.

Hypertension will need to be treated and ensure that patients withhypertension take their medications and measure their blood pressureregularly and also minimize consumption of fatty and salty foods,Exercising daily even simple walking for 30 minutes can be helpful.

Taking into consideration the fact that most mature adults take atleast six prescription medications, four nursing interventions thatcan help prevent problems caused by multiple interactions in olderpatients can be: Clear education and information about medications.Medications need to be accurately listed and there is need to discussthe dosages and the frequency of taking medications. If the patientcannot read, a family member needs to be educated on the medicationsthe patient is taking to ensure proper supervision. Patients need tobe informed why they are taking the medications and also and thedanger to take an overdose.

"Polypharmacy refers to the effects of taking multiplemedications concurrently to manage coexisting health problems"(Woodruff, 2010). Patients taking many medications need specialcontainers which are clearly labeled with the frequency and times thatthe medication needs to be taken. Patients will clearly needsupervision of the medications they are taking. Patients need tobe aware not to share medications and also store medications in asecure dry area away from light to prevent decomposition and loss ofpotency. Old medications and expired drugs should be disposed.

Color coding of different medications is very important as thepatient will keep a memory of the color codes. Most important,physicians and health providers should minimize the number ofprescription drugs for older adults and keep dosing schedules simpleand also avoid change of medications frequently if possible. Also useof single medicines for the illness than prescribing multiplemedications for the same illness or condition.

Reference

Copstead, L.C. & Banasik, J.L. (2012). Pathophysiology(5th ed.). St. Louis; MO.Retrieved from http://evolve.elsvier.com/Copstead

National Heart, Lung and Blood Institute. (n.d.). Heart failure.Retrieved from https://www.nhlbi.nih.gov/health-topics/heart-fail…

Woodruff, K. (2010). Preventing polypharmacy in older adults.American Nurse Today. 5 (10), 1-7, Retrieved from https://www.americannursetoday.com/preventing-poly…

Disccussion 2

1. What nursing interventions are appropriate for Mrs. J. at thetime of her admission?

At time of Admission Mrs. J requires intervention for her breathing.Not only does Mrs. J feel that she cannot get enough oxygen, shereports feeling weak, and extremely anxious, which is all signs ofpoor oxygenation. With a SpO2 of 82% Mrs. J requires supplementaloxygen. Mrs. J also has blood tinged, frothy sputum which is a sign ofpulmonary edema (pulmonary edema, 2018). Along with the decreasedbreath sounds, pulmonary crackles Mrs. J is not only startingrespiratory failure she is also experiencing left sided heart failureand the build up of fluids. Mrs. J needs Lasix to help her body startto get rid of the excess fluid in her system. With a prolonged periodwithout the proper amount of oxygen in the body Mrs. J heart couldsuffer the consequence. “When metabolic demand for oxygenexceeds supply, the myocardium becomes ischemic, which leads to adysfunction in cardiac pumping and predisposes to abnormal heartrhythms. If the ischemic episode is severe or prolonged, irreversibledamage to myocardial cells may result in MI” (Copstead-Kirkhorn.(2010) page 429)

Mrs. J should get an EKG if it was not already done in the Emergencyroom to get a good look at the heart. With atrial fibrillation Mrs. Jhas an increase risk for experiencing a stroke. When listening to theheart S3 sounds are present. S3 sounds could indicate ventricularfailure. “The third heart sound (S3), when audible,occurs early in ventricular filling, and may represent tensingof the chordae tendineae and the atrioventricular ring, which is theconnective tissue supporting the AV valve leaflets. This sound isnormal in children, but when heard in adults it is often associatedwith ventricular dilation as occurs in systolic ventricularfailure” (Heart Sounds, para 3).

Mrs. J has been not taking care of herself for a while and findsherself critically ill. She is feeling anxious due to not being ableto breath properly, due to hospitalization, and fear of the unknown.Nurses should do their best to explain everything that they are doingto Mrs. J. short, simple explanations can help a patient feel more atease about the situation, and put trust in the health care staffcaring for them.

1. Drug therapy is started for Mrs. J. to control hersymptoms. What is the rationale for the administration of each ofthe following medications?

1. IV furosemide (Lasix): Promotes diuresis and the excretion ofexcess fluid. Used with heart failure patients and with hepaticimpairment. We know due to the jugular vein distention, cracklesin lungs, pulmonary edema, and other signs and symptoms Mrs. J hasthat she has excess fluid in her body that her body is unable toget rid of on its own. Lasix helps excrete the fluid. Although themain concerns we were looking at is heart failure, it is indicatedthat Mrs. J has hepatomegaly, so she may have issues with herliver as well. (Vallerand, Sanoski, & Deglin, 2017)

1. Enalapril (Vasotec): An ACE inhibitor used in the managementof hypertension in patients with heart failure. This medication isused because of Mrs. J’s comorbidities and due to her havingheart failure signs and symptoms. (Vallerand, Sanoski, &Deglin, 2017)

1. Metoprolol (Lopressor): Beta blocker that is used incombination with ACE inhibitors for management of hypertension andis used in patients with heart failure. “IndicationsHypertension. Angina pectoris. Prevention of MI anddecreased mortality in patients with recent MI. Management ofstable, symptomatic (class II or III) heart failure due toischemic, hypertensive or cardiomyopathc origin (may be used withACE inhibitors, diuretics and/or digoxin; Toprol XL only)”(Vallerand, Sanoski, & Deglin, 2017).

1. IV morphine sulphate (Morphine): an opioid analgesic that isusually used for pain. However, morphine can also be used forpulmonary edema. Morphine also helps anxiety and reduces oxygendemand. (Vallerand, Sanoski, & Deglin, 2017).

1. Describe four cardiovascular conditions that may lead to heartfailure and what can be done in the form of medical/nursinginterventions to prevent the development of heart failure in eachcondition.

1.Atherosclerosis: “Atherosclerosis causes progressivenarrowing of the arterial lumen and predisposes to a number ofprocesses that can precipitate myocardial ischemia, including thrombusformation, coronary vasospasm, and endothelial cell dysfunction”(Copstead-Kirkhorn. (2010) page 429) Medications that help withatherosclerosis is statins, aspirin, and angiotensin inhibitors.Nursing interventions include: assisting with smoking cessation,control of diabetes, and dietary changes to promote healthier lifestyle.

2. hypertension: patients should take prescribed blood pressuremedication and follow up with primary doctor to determineeffectiveness. Nursing interventions include, smoking cessation,instructions on taking medication, and exercise.

3. cardiomyopathy: is enlargement of the heart from infections ordrug and alcohol abuse. ("Congestive Heart Failure and HeartDisease", 2018). Nurses can assist patients in getting rehab fordrug addiction and teach a sober lifestyle.

4. valve disease: can increase the work load of the heart which canincrease risk for heart failure. ("Congestive Heart Failure andHeart Disease", 2018) nurses should teach patients to lead activehealthy lifestyle and to look for signs and symptoms of heart failurelike swelling, and report to primary doctor as soon as signs begin.

1. Taking into consideration the fact that most mature adultstake at least six prescription medications, discuss four nursinginterventions that can help prevent problems caused by multiple druginteractions in older patients. Provide rationale for each of theinterventions you recommend.

1. Nurses should assist patients in organizing. Many times, whenpatients have a lot of medication it is easy to forget to takemedication, or can not remember if they took the medication, andthey take it again accidently double dosing themselves. Getting amedication organizer can reduce these errors and help patients taketheir medication as appropriate. ("Preventing polypharmacy inolder adults", 2017)

1. Technology has greatly assisted in checking for druginteractions. “Advances in information technology, such aselectronic prescribing, electronic medical records, and electroniclaboratory records, are innovative ways to decrease the risk ofadverse drug reactions and interactions” ("Preventingpolypharmacy in older adults", 2017)

1. Limiting health care providers could help in the safety ofmedication. When a patient sees a new doctor, they should provide adetailed list of all medications and supplements they are taking.The patient should inform their primary doctor of any medicationchanges the new doctor wishes to make before implementing thechange. ("Preventing polypharmacy in older adults",2017)

1. Nurses should teach patients about any dietary restrictionsthat their medication requires, and nurses should teach potentialside affects so the patient knows what to expect and when to seekemergency care. “Inform patients of any dietary restrictionsnecessitated by a specific medication. During healthcareappointments, teach the patient about potential side effects,including when to call the clinic or go to the emergency room”("Preventing polypharmacy in older adults", 2017)

Reference

Copstead-Kirkhorn. (2010). Pathophysiology, 4th Edition.[Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978141605…

Congestive Heart Failure and Heart Disease. (n.d.). Retrieved June19, 2018, from https://www.webmd.com/heart-disease/guide-heart-fa…

Heart Sounds. (n.d.). Retrieved June 18, 2018, fromhttp://www.cvphysiology.com/Heart Disease/HD010

Preventing polypharmacy in older adults. (2017, September 19).Retrieved June 19, 2018, from https://www.americannursetoday.com/preventing-poly…

Pulmonary edema: MedlinePlus Medical Encyclopedia. (n.d.). RetrievedJune 18, 2018, from https://medlineplus.gov/ency/article/000140.htm

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017).Daviss drug guide for nurses. Philadelphia: F.A. DavisCompany. Retrieved June 18, 2018, from search.ebscohost.com/login.aspx?direct=true&db=nrc&AN=2009535797&site=nrc-live.

Discussion 3

Mrs. J’ symptomsare typical of congestive heart failure (CHF), which occurs whenthe heart cannot provide adequate oxygenation or nutrients to thebody. Her presenting symptoms at admission, as well as hercardiovascular and pulmonary findings are of left ventricularfailure. Patients often appear anxious, have a productive cough,hypoxia, and an enlarged liver. Her tachycardia, tachypnea,and hypotension are all due to her state of decompensation. Her S3present with a ventricular rate of 132 and atrial fibrillation areof concern as well.

Thedecreased cardiac output will be affecting vital organs. Mrs. J isalready retaining fluid, thus the need for furosemide. Loopdiuretics are used for the symptomatic relief of sodium and waterretention. Beta-blockers (metoprolol), and angiotensin-convertingenzyme (ACE) inhibitors have been the main medical treatment ofchoice for CHF for decades. They work by neurohormonal suppressionand reducing the ejection fraction (Oni-Orisan & Lanfear, 2014).Digoxin is another drug that could be used but at very low levels.Morphine is usually prescribed in the sickest patients, althoughrecent literature shows it can cause some harm as well (Agewall,2017). In this case, it was probably used for lowering herheart rate and respiratory rate, but it can also cause respiratory depression.

Acute MI, tachycardia,bradycardia, fluid and salt retention are some conditions that canlead to heart failure. Nurses and physicians must assesspatients with these symptoms for any signs of knowledge deficitregarding the causes of their conditions and educate them on theimportance of taking their medications as prescribed, to preventfurther medical complications. Many of these patients facethe issue of polypharmacy. In many cases, if the patientdoes not have enough money they may choose to take one drug overthe other one. I had a patient that stopped taking his bloodpressure medicine because at the last visit his BP wasnormal. I explained to him the reason it was normal it wasbecause of the medication. The risk of drug interaction isone that the nurse should be aware of and be able to review thelist of medications with the patient at each visit. Sheshould recommend to the patient to always fill the prescriptionsat the same pharmacy, so there is a record of all the medicationstaken for the pharmacist to be able to contact the prescriber ofany drug interactions. The nurse, as a patient advocate,should assess for any financial, economic or social conditionsthat may keep the patient from taking the prescribed medicationsand follow-ups in the clinic.

References

Agewall,S. (2017, July, 2017). Morphine in acute heart failure. Journalof Thoracic Disease, 9(7), 1851-1854. https://doi.org/10.21037/jtd.2017.06.129

Oni-Orisan,A., & Lanfear, D. (2014). Pharmacogenomics in heart failure:where are we now and how can we reach clinical application.Cardiology in Review, 22(5), 193-198. https://doi.org/10.1097/CRD.0000000000000028.

Discussion 4

The nursing interventions that are appropriate for Mrs. J at the timeof her admission is to immediately get her hooked up to a continuousheart rate monitor, have her sit in a high fowler's position topromote better respirations and keep her calm. It can be ascary thing being admitted to the hospital. Often timeswhen a patient is first admitted, so many things are happening atonce, nurses and other health care professionals forget to take a stepback and see if the patient is okay, if they have any immediatequestions, ease their fears and anxiety and just being a caring handto hold.

The rationale for initiating IV Lasix is to eliminate the excesswater in Mrs. J’s body. According to Ogbru (2018b),when Lasix is administered its function is to block the absorption ofwater, sodium and chloride by the body. By doing this there is a largeincrease in urine production. Mrs. J had pulmonary cracklesand decreased breath sounds which could indicate she is fluid overloaded.

Vasotec was also initiated for Mrs. J to relieve the symptoms shewas experiencing. Vasotec is an ACE Inhibitor. An ACE inhibitor standsfor Angiotensin Converting Enzyme Inhibitor. These types ofmedications enlarge the blood vessels which allows the heart to pumpblood easier and lower a person’s blood pressure (Ogbru, 2018a,What are ACE inhibitors and How Do They WorkSection). Because Mrs. J is exhibiting signs of worseningheart failure, administering an ACE inhibitor such as Vasotec willallow her heart to pump the blood slower which will improve her heartsoverall function.

Lopressor is a beta blocker. A beta blockers job is to blocknorepinephrine and epinephrine at their receptor sites (Kow & Ong,2011). By doing this, Mrs. J’s increased heart rate will slowdown which means that her heart will be beating with less force.

Morphine was also administered to Mrs. J. When people think ofMorphine, they usually think of a narcotic that relieves pain.Although there are not many studies to support it fully, morphine canbe given in the early stages of acute heart failure due to itssedative and also hemodynamic properties. Morphine can reduce thehearts oxygen demand by decreasing the preload and heart rate (Coons,McGraw, Murali, 2011, para. 1). Giving Morphine to Mrs. J will notonly relax her in this tense and scary situation she is going through,it can also provide more oxygen to her heart by almost relaxing it.

There are many things that can contribute to a person having heartfailure. Having coronary artery disease can lead to heartfailure. Coronary artery disease is when the arteries ofyour heart have a build of up cholesterol. This means thatless blood is able to flow through freely. This buildup inthe arteries can lead to an increase in blood pressure which lead canlead to heart failure (American Heart Association,2017). Being obese can also be a contributingfactor. Because of the excess weight, it causes the heartto work harder compared to a non- obese person. Being a diabetic canalso increase a person’s risk for developing heartfailure. People who have diabetes, especially Type IIdiabetes, tend to be overweight, lack physical activity, have anincreased cholesterol level and elevate blood pressures (AmericanHeart Association, 2018). All of these things that accompany thediabetes increase a person’s risk greatly for heart disease.Hypertension is another cardiovascular condition that may eventuallylead to heart failure. When a person’s pressure withintheir blood vessels remains high, it means that the heart is having towork much hard to pump the blood throughout the body. If it goesuncontrolled and not properly treated it can cause the chambers of theheart to become much weaker and larger, which then can increase yourrisk for heart failure (American Heart Association, 2017). Also, ifsomeone has suffered a heart attack before has a much higher risk ofdeveloping heart failure compared to others. Having a heart attackdamages the muscle tissues of the heart which means that the heartdoes not contract as easily as it did before making it pumpingabilities weaken (American Heart Association, 2017).

To prevent heart failure in patients with each of thesecardiovascular conditions the first nursing intervention that shouldbe done is education. If a patient is not properly educated on thereasons they are being treated for the condition they have, on themedication they may be taking, signs and symptoms of heart failure,when they should seek medical attention, and what could happen if theydo not treat their cardiovascular condition, it puts them at greaterrisk. In addition to education, for a person with coronary arterydisease, ensuring that they are adhering to a proper diet that canreduce their cholesterol intake and making sure they are taking anymedications that they are prescribed. For obesity, assisting withexercise regimens, referring them to support groups and education onconsuming a healthy and well- balanced diet to help them to loseweight can decrease their risk of heart failure. For a diabeticpatient, making sure that their blood sugars are well controlled,their following a proper diabetic diet, increasing their physicalactivity and taking their medication as ordered. Patients withHypertension should check their blood pressure on a daily basis aswell as their medication. Checking their blood pressure daily willensure that they are on the proper medication, it is the right doseand their blood pressures are normotensive. Also, decreasing sodiumintake and eating a diet high in fruits and vegetables and increasingphysical activity can also decrease their blood pressure without theuse of medications. All of these conditions also require that thepatients are seeing their doctor on a regular basis and getting anylab tests done that are required.

As a person grows older, more health issues usually arise whichmeans that the older you get, the more medications you aretaking. This can sometimes be confusing for the olderadult. They can get confused on when to take which pill, how manytimes a day, if they have to take the pills with food or should theybe on an empty stomach, or if any of the medications have interactionswith each other. A nursing intervention to prevent drug interactionsis medication education. Providing detailed yet easy to understandeducation on the medication such as what that medication is for,common side effects, when to take it and what to not take it with.Another nursing intervention to go along with the first interventionis to keep an accurate list of each medication. This list shouldinclude both the generic names and any brand names it may have, apicture of what the medication looks likes, the purpose of it and theside effects. Keeping a list like this posted on a cabinet door orsomewhere where the medications are stored allows the patient easyaccess to if and when there should be a question about themedication. Sometimes medication bottles can be confusingand the print on them is hard to read. Taking each medication andplacing it in a new container labeled largely with the name of themedication, time it should be taken, and what to avoid taking it withon the top is a fool proof way for older patients to not miss taking adose and avoid taking it the incorrect way. Lastly, another way toreduce the risk for drug interactions is to urge older patients not toshare medications. Medications can be very costly. However, sharingmedications between friends or family to save money may cost you inother ways. By not sharing medications with others you avoid the riskof overdosing, taking a medication that you are not prescribed, takinga medication that could interfere with another one you are alreadytaking or taking a medication that you could have a allergic reaction to.

References:

American Heart Association. (2017, May 8). Causes of Heart Failure.Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

American Heart Association. (2018, January 29). CardiovascularDisease and Diabetes. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/Diab…

Coons, J. C., McGraw, M., & Murali, S. (2011). Pharmacotherapyfor Acute Heart Failure Syndromes. American Journal ofHealth-System Pharmacy,68(1), 21-35. Retrieved from https://www.medscape.com/viewarticle/735149_8.

Kow, F. P., & Ong, H. T. (2011). Beta-blockers for heartfailure: Why you should use them more. The Journal of FamilyPractice, 60(8), 472-477. Retrieved from https://www.mdedge.com/jfponline/article/64412/cardiology/beta-blockers-heart-failure-why-you-should-use-them-more.

Ogbru, O. (2018a). ACE Inhibitors Drug Class Side Effects, List ofNames, Uses, and Dosage. Retrieved from https://www.medicinenet.com/ace_inhibitors/article…

Ogbru, O. (2018b). Furosemide. Retrieved from https://www.medicinenet.com/furosemide/article.htm…

Discussion 5

What nursing interventions are appropriate for Mrs. J. at thetime of her admission? Drug therapy is started for Mrs. J. tocontrol her symptoms. What is the rationale for the administrationof each of the following medications?

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)

Given the condition that Mrs. J. is suffering from, the bestinterventions that are appropriate at the time of her admission wouldinclude administration of oxygen thru intubation since she hasdifficulty in breathing, administration of diazepam or any anxiolyticwhich could allow the patient to relax and finally provide anantibiotic that would help her manage the respiratory infectionspecified by pharyngitis.

What is the rationale for the administration of each of thefollowing medications?

IV furosemide (Lasix)

Administration of IV furosemide (Lasix) will help decreaseextravascular volume by persuading diuresis therefore reducing preloadand the work of the heart in pumping blood is decreased hence preventprogression of heart failure.

Enalapril (Vasotec)

Given that Enalapril is an ACE inhibitor (angiotensin-convertingenzyme inhibitor), which prevents the constriction of blood vessels.As a result, it leads to the vasodilation of peripheral vesselspreventing the prevalence of heart failure.

Metoprolol (Lopressor)

Despite being used as a beta-blocker which affects the heart andcirculation (blood flow through arteries and veins), metoprolol isused in the treatment of angina (chest pain) and hypertension (highblood pressure). It can be used in this case to prevent possible casesof heart attack.

IV morphine sulphate (Morphine)

This drug belongs to a class of drugs known as opioid (narcotic)analgesics whose main role is management of pain.

Describe four cardiovascular conditions that may lead to heart failure

Different cardiovascular conditions exist that may lead to heartfailure, for instance,

Coronary artery disease: This mainlylead to heart failure when cholesterol and fattydeposits build up in the heart's arteries, limiting the amount ofblood reaching the heart muscle. This build-up is known asatherosclerosis. The result may be chest pain (angina) or, if bloodflow becomes totally obstructed, a heart attack.

Myocardial infarction: this can occur when anartery that supplies blood to the heart muscle gets blocked. The lossof oxygen and nutrients damages the heart's muscle tissue – partof it essentially "dies." The damaged heart tissue does notcontract as well which weakens the heart’s ability to pumpblood, hence, leading to heart failure.

High blood pressure (hypertension or HBP): this is amajor risk factor for developing heart failure. When pressure in theblood vessels is too high, the heart has to pump harder than normal tokeep the blood circulating. This takes a toll on the heart, and overtime the chambers get larger and weaker; that can as a result lead toheart failure.

what can be done in the form of medical/nursing interventionsto prevent the development of heart failure in each condition.

To prevent the occurrence of heart failure monitoring the bloodpressure is important to prevent abnormal blood pressure henceoverworking the heart. Monitoring the blood sugar can help preventhypertension and atherosclerosis from leading to elevated lipid levelsin the blood, the monitoring can also help prevent and decrease theblood sugar levels. Also, monitoring the levels of cholesterol canhelp reduce chances of getting coronary artery disease that can laterlead to heart failure.

Taking into consideration the fact that most mature adultstake at least six prescription medications, discuss four nursinginterventions that can help prevent problems caused by multiple druginteractions in older patients. Provide rationale for each of theinterventions you recommend

The nursing interventions that could help prevent problems caused bymultiple drugs interactions in older patient include;

Maintaining an accurate list and record of all drugs administered tothe patient. The process is important since it can help the physiciansunderstand the medications they administered to the patient hencepreventing addition of the same medications.

Patient education. This would include giving sufficient info to thepatient to keep an updated status between the physician and thepatient, hence helping to guide the patient on the right drug to useand at which period.

Also, helping the patient to manage their drugs by assigning ahomecare nurse can ensure that the patient completes the drugs anddisposes expired medications.

References

American Heart Association (2017). Causes of Heart Failure.Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A.,Böhm, M., Dickstein, K., … & Jaarsma, T. (2012). ESCGuidelines for the diagnosis and treatment of acute and chronic heartfailure 2012. European journal of heartfailure, 14(8), 803-869.

MayoClinic (2017). Diseases and Conditions: Heart failure. Retrievedfrom https://www.mayoclinic.org/diseases-conditions/hea…

Discussion 6

In the event of Mrs. J it would be appropriate to say that heradmission due to acute decompensated heart failure is due to hernoncompliance of not taking her heart medications for 4 days andcontinuous smoking history. Although her diet is unknown it could alsobe an affect to her current condition. In congestive heart failure(CHF) there is a problem with the pumping of the heart making itdifficult for the heart to pump blood to the rest of the body andcausing a backup flow of fluids to your lungs and body, (Health Line,2018). In Mrs. J’s case her heart and blood medication are tohelp her keep her CHF controlled and when noncompliant along withother things like poor diet and exercise, it can cause acute heartfailure, a worsening of her uncontrolled CHF, where new onset symptomscan arise, (Arrigo, Parissis, Akiyama, & Mebazaa, 2016).Which in Mrs. J’s case she has developed difficultybreathing, palpitations, and exhausted.

Upon admission the appropriate interventions for Mrs. J is to firstto provide her oxygen supply due to her difficulty breathing and pulseoximetry of 82%. These signs indicate that she is not receiving enoughoxygen on room air, therefore administering oxygen is appropriate.Sitting her up in high fowlers is also the appropriate interventionbecause she is experiencing fluid buildup, in other words retainingfluid, as evidence by pulmonary crackles, and decrease breath sounds.Laying her flat can create more fluid to backup into the lungs causinggreater difficulty in breathing. Appropriate medications should beadministered as well as a continuation of cardiac assessment, vitalsigns, and monitoring is essential for any changes in condition.

Medications like furosemide (Lasix) is administered to move fluidthat is build up in the lungs and body out the body through urination.Furosemide (Lasix) is a loop-diuretic that acts on the kidneys toproduce urine from the fluid buildup in the body which helps theexcess fluid to be removed through urination and out of the body,(Health Line, 2018). In Mrs. J’s case it will help the fluidbuildup in her lungs and body to be removed and help improve her condition.

Enalipril (Vasotec) is an angiotensin-converting enzyme inhibitor(ACE inhibitor) that is used for blood pressure, and CHF. It helps thevessels to dilate so that blood can properly flow to your heart andbody, therefore improving blood flow, (Health Line, 2018). In Mrs. Jcase Enalapril is given to help the blood flow so that the heart isable to pump more easily.

Metoprolol (Lopressor) is a beta-blocker that can reduce high bloodpressure as well as rapid uncontrolled heart rate, therefore used toslow and control the heart rate to normal rate, (Health line, 2018).In Mrs. J’s case it given to control her rapid heart rate of 118and irregularity.

Morphine is a an opioid that is used for pain, however reported toreduce preload, heart rate, and afterload and help dilate the vesselswhich in CHF is needed to help reduce the oxygen demand in the heart,it is also know to decrease anxiety and help relaxation for betterbreathing, (Coons, McGraw, Murali, 2011). In Mrs. J’s caseshe is having heart failure symptoms of her heart overworking causingher a rapid heart rate and difficulty breathing that is giving heranxiety. Morphine will her fell less anxious and decrease her feelingof not being able to breath.

There are many cardiovascular conditions that can lead to heartfailure like hypertension, coronary artery disease, abnormal valves,and damage to the heart like cardiomyopathy or a previous heart attack.

Hypertension is known as high blood pressure. It is when thepressure in the heart is too high and has to puck harder than normalto get blood to flow causing an overwork on the heart, (American HeartAssociation, 2018). It is important that as a nurse the patient iseducated on the importance of blood pressure control through exercise,diet, and medication compliance.

Coronary artery disease is due to high cholesterol in blood andplaque build-up in the arteries causing obstruction of blood flowwhich can lead to chest pain and heart attack causing heart failure,(American Heart Association, 2018). As a nurse education on ahealthy diet and exercise is essential to control cholesterol. Medicalinterventions like cholesterol medications or if more serious cardioprocedures like stenting of the heart is appropriate.

Abnormal Valves in the heart is a defect on the valves of the heart,a malfunction where they do not close or open properly causes theheart to overwork and over stress itself that eventually can result toheart failure, (American Heart Association, 2018). In this situationeducation about the heart valves and following up with a cardiologistis essential procedures to repair the defected heart valves.

Cardiomyopathy is an enlarged heart due to heart damage. The damagecan be from drug use, birth defects, heart attack or unknown reasons,(American Heart Association, 2018). The appropriate interventions areto regularity follow up with a cardiologist, cardiac medications, andcardiac diet.

Polypharmacy is referred to the effects of too many drugadministrations, (American Nurses Today, 2018). Many older adults takemore than three prescription drugs due to multiple health issues,therefore medication management is very important to help prevent druginteractions, miss doses, or even drug overuse. As a nurse to helppolypharmacy risk in patients from occurring it is important todiscuss the medications with patients and the importance of having anup to date medication list of all prescription and over the countermedications, vitamins, herbal, doses, frequency, and reason (AmericanNurses Today, 2018). It is important that they keep the list updatedand that they provide a copy to all care providers as well as use thesame pharmacy for all prescriptions to avoid confusion. This isimportant to avoid duplication and drug interactions. It is importantto teach the patient what each drug is for and what it does so thatthey have an understanding of why the drug is needed and important totake as directed. It is also important to teach them about abnormalsigns when taking current or new medications, and when it is essentialto report to a healthcare provider, this will help avoid any urgent oremergency situation, (American Nurses Today, 2018). For some olderpatients remembering to take medications and the purpose can bedifficult to remember, therefore organizing daily medications byseparating morning and night using a pill/medication organizer canhelp ,as well as teaching them the colors of each pill, (AmericanNurse Today, 2018). This will help avoid confusion and help remindthem to take their pills daily.

References

American Heart Association. (2018). Causes of heart Failure.Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFail…

American Nurses Today. (2018). Preventing Polypharmacy in OlderPatients. Retrieved from https://www.americannursetoday.com/preventing-poly…

Arrigo, M., Parissis, J., Akiyama, E., Mebazaa, A. (2016).Understanding acute heart failure: pathophysiology and diagnosis.European Heart Journal Supplements, Vol 18. Pg. G11-G18. Retrievedfrom https://academic.oup.com/eurheartjsupp/article/18/…

Coons, J., McGraw, M., Murali, Srinivas. (2011). Pharmacotherapy forAcute Heart Failure Syndromes. Retrieved from https://www.medscape.com/viewarticle/735149_8

Health Line. (2018). What are the most common types of CHF?.Retrieved from https://www.healthline.com/health/congestive-heart…