Question

Please help

Please help me with this

Patient is 72 year old. patient has a problem are CHF, COPD, Sob, and history with PTSD, MDD, Anxiety, HTN, CA kidney

Base on patient problem, Please help me question below

1. Nursing Diagnosis #1)

a. State rationale for choosing this diagnosis:

b. Nursing Process: Planning and Intervention: Goals and Interventions: Develop one goal and four interventions for each diagnosis. One intervention should include patient education.

Goal (S.M.A.R.T.):

c. Nursing Interventions to achieve goal:

1.

2.

3.

4.

d. Evaluation: Please describe how your patient met/did not meet goal:

2. Nursing Diagnosis #2)

a. State rationale for choosing this diagnosis:

b. Nursing Process: Planning and Intervention: Goals and Interventions: Develop one goal and four interventions for each diagnosis. One intervention should include patient education.

Goal (S.M.A.R.T.):

c. Nursing Interventions to achieve goal:

1.

2.

3.

4.

d. Evaluation: Please describe how your patient met/did not meet goal

Answer 1

1.Impaired cardiac output related to structure abnormalities or myocardial alterations as evidenced by increased blood pressure.

a.Rationale :CHF occurs due to varied reasons resulting in decreased ejaculation fraction which leads to circulatory problems associated with affecting the functions of vital organs(lungs,kidney,brain)

b.Nursing process

Goals:

• To ease patient from dyspnea by relieving stress on heart

Intervention

• Monitor vital signs which gives baseline information in providing care. (Apical pulse ,peripheral pulse,heart rate and rhythm to rule out circulation  , sounds to assess murmurs, BP is increased initially due to increased SVR
• Administer medication to relieve vasoconstriction,eliminate excess fluids,ACE inhibitor to normalise  blood pressure ,blood thinnersto prevent clotting,digoxin and as per symptom
• Monitor patient lab values like LFT,creatinine, BUN,PT,APTT because changes occurs in this values
• Provide the patient with oxygen support to overcom dyspnea
• Maintain strict intake and output to care patient from any complication

Evaluation

• The patient will have an decreased stress on heart by observing the normalisation of high BP

2.Impaired gas exchange related to decrease oxygenation as evidenced by breathlessness secondary to CHF

a.Rationale:The main complaint of these patients are difficult to breath and thriving for oxygen which when given in excess can be dangerous

b.Nursing process

Goal:

• To maintain normal oxygen level

Nursing intervention

• Monitor patients vital signs (respiratory rate,oxygen saturation,capillary circulation ) to get the base line data
• Administer medication (bronchodilators, corticosteroids ,nebulization) to enhance breathing
• Administer oxygen (0.5 L to 2 L/minute strictly )
• Provide propped up position this will increase the lung capacity

Evaluation

The patient vital signs should be in normal limit

Patient able to maintain normal saturation level.