Question

Mr. Pepper is 74 y/o who presented to the ED with shortness of breath, fatigue, and “swollen legs and stomach”. In assessing his health history, you found out that he smokes a pack a day. His wife reported that he has been sleeping with two pillows propped behind him. Upon further evaluation Mr. Pepper reported that he had not been taking his fluid pill because he ran out. In obtaining his assessment, you noted bilateral crackles, bilateral lower edema of +3 and distended abdomen. His V.S. are: BP 92/48, P 88, R 30, T 98.9, SPO2 of 88% on room air. You decide to supplement him with 2 L of O2. Mr. Pepper was admitted to 6 South for Heart Failure exacerbation and for diuresis. He was administered Lasix with Potassium supplements. He stated relief from his fatigue and shortness of breath. During hospital stay you noted that his wife was bringing him Chinese food. The patient also requested multiple times to go outside and smoke. Upon discharge, Mr. Pepper was in good spirits and ready to go home. He was educated about his heart failure and disease process and management throughout his hospital stay.

What other interventions might the nurse consider? What procedures, medications and labs do you anticipate?

Answer 1

The following interventions had to be considered by a nurse when caring for these types of patients

• Maintaining fluid chart or intake and output chart to assess the progress and prevent any complications
• Monitor vital signs periodically
• Assess patient for eating any Chinese foods which are generally not good for heart
• Providing psychological support to ease and support in breathing
• Elevation of lower limb to prevent edema
• Administration of medications as over order
• Monitoring for any side effects or adverse events to the drug administered
• Providing salt free ,low fat diet
• Observe for any smoking by the patient

Procedures

• Cardiac resynchronization therapy
• Central line insertion to monitor CVP and administer medication  

Medication

• Vasoconstrictor to raise blood pressure
• Bronchodilator to improve breathing
• Digoxin
• Flu vaccine

Laboratory investigation

• ECG: to rule out rhythm and a base line information can be obtained
• Sr.Electrolyte:lasix can result in loss of excess sodium which can alter sdnsorium if happened
• ABG to analyse the gas levels
• Chest x Ray to know the lungs and heart
• BNP to rule out active heart failure
• CBC to know the haemoglobin level
• Lipid level