Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension,
chronic heart failure, and sleep apnea. She has been smoking two packs
of cigarettes a day for 40 years and has refused to quit. Three days
ago, she had an onset of flu with fever, pharyngitis, and malaise. She
has not taken her antihypertensive medications or her medications to
control her heart failure for 4 days. Today, she has been admitted to
the hospital ICU with acute decompensated heart failure.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is so exhausted she cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5 kg
2. Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
3. Cardiovascular: Distant S1, S2, S3, S4 present; PMI at sixth ICS and
   faint; all peripheral pulses are 1+; bilateral jugular vein distention;
   initial cardiac monitoring indicates a ventricular rate of 132 and
   atrial fibrillation
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
5. Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of
her admission? Drug therapy is started for Mrs. J. to control her
symptoms. What is the rationale for the administration of each of the
following medications?

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)

Describe four cardiovascular conditions that may lead to heart
failure and what can be done in the form of medical/nursing
interventions to prevent the development of heart failure in each
condition.

Taking into consideration the fact that most mature adults take at
least six prescription medications, discuss four nursing interventions
that can help prevent problems caused by multiple drug interactions in
older patients. Provide rationale for each of the interventions you
recommend.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension,
chronic heart failure, and sleep apnea. She has been smoking two packs
of cigarettes a day for 40 years and has refused to quit. Three days
ago, she had an onset of flu with fever, pharyngitis, and malaise. She
has not taken her antihypertensive medications or her medications to
control her heart failure for 4 days. Today, she has been admitted to
the hospital ICU with acute decompensated heart failure.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is so exhausted she cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5 kg
2. Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
3. Cardiovascular: Distant S1, S2, S3, S4 present; PMI at sixth ICS and
   faint; all peripheral pulses are 1+; bilateral jugular vein distention;
   initial cardiac monitoring indicates a ventricular rate of 132 and
   atrial fibrillation
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
5. Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of
her admission? Drug therapy is started for Mrs. J. to control her
symptoms. What is the rationale for the administration of each of the
following medications?

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)

Describe four cardiovascular conditions that may lead to heart
failure and what can be done in the form of medical/nursing
interventions to prevent the development of heart failure in each
condition.

Taking into consideration the fact that most mature adults take at
least six prescription medications, discuss four nursing interventions
that can help prevent problems caused by multiple drug interactions in
older patients. Provide rationale for each of the interventions you
recommend.

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