Question

John is a 59-year-old man admitted to the emergency department with complaints of severe shortness of breath and a cough producing frothy, blood-tinged mucous. His history reveals a myocardial infarction 2 years ago. Since then, he has been on a low-salt diet, digoxin, and furosemide for control of congestive heart failure.

The client is admitted to the hospital for treatment of acute pulmonary edema secondary to congestive heart failure. On his fourth hospital day, the client complains of tingling and numbness of his fingers, muscle weakness, and palpitations. His electrocardiogram shows frequent premature ventricular contractions (PVCs). Four hours later, he is confused and restless.

The client’s diagnostic findings are as follows:

Arterial Blood Gases: pH 7.55, PaCO2 25 mm Hg, HCO3 34 mEq/L, PaO2 65 mm Hg, SaO2 91%

Hematology: K = 2.5 mEq/L

A.What nursing actions can be implemented to address the client’s priority nursing diagnoses?

B. Discuss the client’s anxiety, hypokalemia, and associated PVCs, acid-base imbalance, hypoxia, and so forth.

C. Consider interventions to control or reduce his anxiety; prevent, monitor, or report abnormal electrolytes or acid-base imbalances; reduce or eliminate hypoxia, and so forth.

Answer 1

A clinical management of a patient with acute pulmonary edema due to left ventricular failure is directed towards reducing volume overload, improving ventricular function and increasing respiratory exchange. These goals are accomplished through a combination of oxygen and ventilatory support ,I'VE medications and nursing interventions. Oxygen is administered in concentration adequate to relieve hypoxaemia and dyspnea. Morphine is titrated Intravenous in small doses to reduce peripheral resistance and venous return so that blood can be redistributed from the pulmonary circulation to other parts of the body Diuretics promote the excretion of dodium and water by the kidneys.

B Impaired lymphatic drainage also contribute to the accumulation of gluid in the lung tissues. The fluid within the alveili mixes with air creating bubbles that are expelled from the mouth and nose, producing the classic symptoms of pulmonary edema such as ftothy oink ,blood yinged sputum. Because of the fluid within the alveoli, air cannot enter and fast exchange is impaired. The result us hipoxaemia which is often severe. The onset maybe preceded by premonitory symptoms of pulmpnary congestion. As a result of decreased cerebral oxygenation, the patient becomes increasingly restless and anxious. Along with a sudden onset of breathlesness and a sense of suffocation, the patients hands become cold and moist ,the nail buds become cyanotic .As pulmonary edema progress the patients anxiety and restlessness increase the patient become confused and then stuporous. Breathing is rspid and noisy. Patients oxygen saturation is decreased and the patient is suffocated by the blood tinged, frothy fluid filling the alveoli is literally drowning in secretions.

C

• Patient is placed in upright position to reduce venous return to the heart, lower income the output of the right ventricle and decreasing lung congestion.
• Reassuring the patient and providing skillful anticipatory nursing care are integral parts of the therapy
• If respiratory failure is severe or persists, continuous positive airway pressure maybe delivered by a facemask with a tight seal
• The patient receiving continuous over infusions of vadoactive drugs require Each monitoring and frequent measurement of vital signs