Question

Please print so I can read it clearly

Client Profile:

L.J. is a 63-year-old man who has a history of hypertension, congestive heart failure and sleep apnea.  He has been smoking two packs of cigarettes a day for 40 years and has refused to quit.   He has not taken his antihypertensive medication or his medications to control his heart failure for 4 days.  He went to the emergency room and now is admitted into the hospital, admitting diagnosis: CHF.

Subjective Assessment Data:

• Is very anxious and asks if he is going to die because he is so short of breath
• Denies pain but say that he feels like he cannot get enough air
• Says he feels like his heart is “running away”
• After weighing himself he reports that he gained 11 pounds and his shoes and waistband are tight
• I don’t like wearing my CPAP at night

Objective Assessment Data:

• Height: 5 feet 10 inches
• Weight: 220lbs
• Vital signs:  T: 99.6, HR: 118bpm and irregular, RR: 34, BP: 142/60, Pulse Ox: 90% (Room air)
• CV: Distant S1, S2, bilateral jugular vein distention, all peripheral pulses were +1 and there was bilateral lower leg edema
• Resp: Pulmonary crackles, decreased breath sounds right lower lobe, coughing frothy blood tinged sputum, shortness of breath on any type of exertion
• GI:  Bowel sounds present, hepatomegaly 4cm below costal margin
• Laboratory work and diagnostic testing is scheduled

1. What 5 discharge patient education topics should be provided to L.J. concerning home management of his congestive heart failure?

2. Based upon the assessment data presented, what are five (5) priority nursing diagnosis?

Answer 1

What 5 discharge patient education topics should be provided to L.J. concerning home management of his congestive heart failure?

Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficient. Hence lesser oxygen in the blood gets to the organs and tissues. Fluid may not move through the body properly resulting in swelling and difficulty breathing. This is known as congestive heart failure. The most common cause of heart failure is coronary artery disease, the narrowing of the blood vessels that supply blood and oxygen to your heart.

Home Management of CHF.

CHF is associated with increased post‐discharge readmission rates, about 30% of readmissions occur within the first week after hospital discharge and 60% within the first two weeks. The only way to prevent early readmission and improve the quality of living is to strictly adhere to the advices provided by the nurse or doctor at the time of discharge.

At the time of discharge the nurse will brief about the things to do done while at home, they are

1- To Know Yourself, - To have a self-awareness about what is happening with-in self is the key to cope with the heart failures. This includes how to identify when to contact medical help , which include

· increasing shortness of breath and reduced tolerance of activity

· consistently awakening in the night, short of breath

· needing more pillows to sleep comfortably

· increasing swelling of legs or ankles

· worsening cough

· worsening dizziness

2- Diet Healthy Eating -Eating a balanced diet is very important in case of heart conditions; cut down on saturated fats and eat at least five portions of fruit and vegetables a day. It is also important not to use too much salt as it can raise the blood pressure and the body tend to retain water. The current daily allowance for salt is 6g = a teaspoonful. Salt is notorious for causing extra fluid to build up in your body and worsen heart failure. Dietary sodium restriction is endorsed by all HF guidelines and is the most frequent self-care behaviour recommended to people with the condition Salt can make one more thirsty, and being thirsty can cause you to drink too much fluid .if you are overweight your heart has to work harder. Healthy eating will help you feel better and lose weight

3- Smoking & Alcohol- Stopping smoking is the single most important thing a smoker can do to live longer. Smoking can deprive the heart of vital oxygen, make the heart beat faster and raise the blood pressure for a short time after each cigarette. Support and nicotine replacement therapy are available to help you stop smoking.   As important as smoking cutting down on alcohol is also highly important to reduce the damage to the heart muscles. It is advised drink no more than: 1-2 units per day (female) 2-3 units per day (male) (1 unit = small glass (100ml) of wine or half a pint of bitter/lager/ cider

4- Take Your Medication as Directed -Your doctor may prescribe a number of different drugs to treat symptoms of your condition, depending on the cause of your heart failure and how severe it is. It’s crucial to stay on top of taking your medication according to your doctor’s recommendations. If you live alone, set up reminders to stay on track, such as placing sticky notes on your bathroom cabinet or fridge, or using an alarm (a handy feature on some pill organizers) as a reminder.

5- Exercise and weight management- Moderate exercise and activity can be beneficial to your heart. Try to continue your usual activity, building this up gradually, and balance it with rest. Remember exercise doesn’t have to be strenuous to be beneficial. A common symptom of heart problems is fluid build-up in the body. An increase in weight is an early sign that fluid is building up. It is highly important to monitor the weight at the same time every day. If one notice an increase of 2.5kg (6lbs) over 2-3 days, or if you notice any ankle, leg or stomach swelling, seek medical advice.

Based upon the assessment data presented, what are five (5) priority nursing diagnosis?

1 Dyspnoea- Shortness of Breath need to be addressed with priority especially when the patient is reluctant to wear the CPAP.

2- Hypertension- BP: 142/60 and High HR118/min

3- Low O2 Saturation- 90%

4- Address the limp oedema – consider elevation of the leg end of the bed

5 - Hepatomegaly