Question

Write a nursing care plan for this case study following the rubric

MANAGEMENT OF PATIENTS WITH COPLICATIONS FROM HEART DISEASE

Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three myocardial infarctions in the last 10 years, he has decreased left ventricular function. Mr. Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he presents to the emergency department with fatigue, generalized weakness, and feelings of “skipping” heartbeats. Upon arrival, he is placed on the cardiac monitor, his vital signs are assessed, and an IV is inserted. He currently denies chest pain, but is experiencing some shortness of breath, and is placed on 2 L of oxygen via nasal cannula.

NURSING CARE PLAN RUBRIC( plese follow the rubric while using the numbers)

Do not write the NCP using a grid format… use an essay format/ bullet point using the numbers of this rubric.

All NCP will be graded according to the following rubric.

1) Definition of the medical diagnosis __________10

etiology/pathophysiology

2) Common signs and symptoms ___________5

3) Potential complications ___________5

4) Head to toe physical assessment you are to write one….use the data in the case if there is none you create it as if this was your patient. ____________10

5) Diagnostic and lab studies ___________5

normal values

expected abnormalities

6) ALL NANADA Nursing diagnoses __________10

7) Develop 3 NANDA priority nursing diagnoses __________10

8) State a patient plan AND goal for each of the __________10

priority nursing diagnosis

9) Write interventions for each of __________10

priority nursing diagnosis

10) Write scientific rationales for you you ___________5

interventions

11) Write evaluation of your interventions __________10

your plan or make changes

12) List of typical medications __________10

category

usual dosage

side effects

patient teaching

Answer 1

Diagnosis - K/c/o congestive heart failure with acute heart failure with k/c/o coronary artery disease with Arrhythmia

Patient is known case of congestive heart failure and coronary artery disease as he has history of 3 myocardial infarcts and decreased left ventricular function. Now is showing symptoms of acute heart failure as he has fatigue,weakness,shortness of breath and skipped heartbeats.  

In the view of his past history of myocardial infarction, his ejection fraction needs to be assessed as it might be reduced in significant manner.

IfIf is associated with chest pain (angina) , angiography is needed. As of now,he doesn't have any chest pain. So initial plan should be immefimme ECG, 2D Echocardiogram, regular BP and sugar monitoring.

He has shortness of breath and is placed on 2L of oxygen. Saturation needs to be monitored continuously. If saturation is not getting maintained,increase oxygen level to 4 L and then 6 L and if required CPAP (continuous positive airway pressure).

Evaluate for Anemia ,so do complete hemogram. Anemia in heart failure is increased risk factor. So ferritin,transferrin saturation,TIBC (total iron binding capacity) levels are to be checked. If ferritin is less than 100 ng/ml and transferrin saturation is less than 20%, IV ferric carboxymaltose is needed.

He has skipped hearbeats,so he needs to be evaluated from cardiorenal complications point of view. Assess renal function and see if he is in renal failure stage. Urea,creatnine, potassium,sodium , urine output is required to be monitored.if he has hyperkalemia (more than 6.5 m mol/l),raised urea (more than 150 mg/dl),creatnine more than 3.5 mg/dl, consider renal replacement therapy.

Assesfor atrial fibrillation . Use of amiodarone is required for rhythm control. Also start anticoagulant warfarin or thrombin inhibitor to prevent stroke.

Diet, nutrition,mild exercise is needed in maintenance phase. In acute heart failure, exercise is to be avoided. Adherence to diet and medication is must.

Restricted sodium intake 2 to 3 gm/day, fluid intake 2 L/day if he has hyponatremia (sodium less than 130 meq/dl) is needed.

List of medications-

Continue medications as prescribed earlier.

1.Diuretics (lasix) to reduce edema by reducing blood volume and Venus pressure)in patients with heart failure and reduced left ventricular function. Start 20 mg IV lasix twice a day

2.ACE inhibitors to be continued for neurohormonal modulation ,to improve vasodilation,LVEF and survival benefits. Captopril 12.5 mg od to be started. Watch for potassium levels. In case of hyperkalemia,stop the drug and start ARB (Angiotensin receptor blocker)like losartan 25 mg or telmisartan 40 mg as starting dose.

3.Add cardioselective beta blocker like metroprolol 50 mg for neurohormonal modulation and improving LVEF. Watch for bradycardia.

4. If ACE inhibitors or beta blockers are not tolerated,cons cons nitrates.

5.Continue Digoxin 0.25 mg , 6 days a week.

6.Ionotropic drug like Adrenalin,epinephrine .

7.Anticoagulant like Warfarin 1mg or direct thrombin inhibitors like low molecular weight heparins like lonopin 40 mg daily will be needed.INR should be 2 to 3.

8.if Arrhythmia is not improved with amiodarone,consider pace maker.

9.While giving discharge,focus on lifestyle modification.

Salt and fluid restrictions

Daily measurements of weight

Light exercise

Weight loss

Avoid stress

Sleep for 6 to 8 hours daily

Compliance to medication strictly

10.Watch for complications and danger signs as below

Sleep apnea

Pulmonary embolism

Renal failure (oliguria/uremia)

Sepsis

Anaemia

Hypoxia