Franco, Danica A.

BSN 3Y1-1

This is an individual work. Please read the case scenario and answer the questions below.

Case Scenario:

Mr. H, an 82-year-old man who is widened and lives alone, arrives in the emergency room complaining he has had difficulty breathing, especially
at night, associated with nausea, for the past week. He states that he must sleep with two pillows to breathe more easily at night and still
does not get a good night’s rest. He also complains of cough that is worse at night and relieved by nothing. Mr.  H has pneumonia. Assessment of
Mr. H reveals the following; Vital signs: temperature, 98F; apical heart rate 86 beat s/min and irregular, respiratory rate, 36  breaths/min and
labored; and blood pressure, 170/96 mmHg Skin – pale, cool, and diaphoresis Inspiratory bibasilar crackles that do not clear with coughingS3,
heart sound on auscultation Visible jugular vein distention3+ bilateral pedal edema, 12-lead ECG and a chest x-ray examination are ordered. An
intravenous line is started at a “keep vein oven” (KVO) rate. Oxygen via mask is admitted with a diagnosis of CHF.

1. What are the signs and symptoms of heart failure?

Answer:

The patent’s signs and symptoms that he shows are:

 Difficulty of breathing
 Nausea
 Cough
 Irregular apical heart rate (86 beats/min)
 High BP (170/96 mmHg)
 Crackles sounds

General signs and symptoms:

 Shortness of breath (dyspnea) when you exert yourself or when you lie down
 Fatigue and weakness
 Swelling (edema) in your legs, ankles and feet
 Rapid or irregular heartbeat
 Reduced ability to exercise
  Persistent cough or wheezing with white or pink blood-tinged phlegm
 Increased need to urinate at night
 Swelling of your abdomen (ascites)
 Very rapid weight gain from fluid retention
 Lack of appetite and nausea
 Difficulty concentrating or decreased alertness
 Sudden, severe shortness of breath and coughing up pink, foamy mucus
 Chest pain if your heart failure is caused by a heart attack

2. Give 7 lifestyle modifications to teach older adults with heart failure and discuss briefly.

Answer:

1. Do exercise (Cardiovascular exercise)- moderate exercise can benefit in general. Why? Activity may improve the functioning of
your heart, by reducing the workload and enabling it to beat more efficiently.
2. Maintain a healthy weight - Maintaining a healthy weight is important to protecting your heart from damage or fatigue. When your
weight is in a healthy range, your blood circulates more effectively and necessary fluid levels are managed, preventing strain on your
heart.
3. Eat a healthy diet- The foods you eat play a huge role in whether you gain too much weight and develop high cholesterol, both of which
can increase your risk for heart disease. 
4. Manage high cholesterol- Too much bad cholesterol and not enough good cholesterol can result in plaque building up on the walls of
arteries. If blood flow becomes restricted, it will lead to heart attack.
5. Manage high blood pressure- Uncontrolled high blood pressure is one of the most deceptive risk factors for heart disease because there
aren’t any physical symptoms — you need to have your blood pressure checked to know if you’re in the heart-healthy range. 
6. Plan periods of rest- Be sure to get plenty of rest. You may need to plan at least one rest period every day. When you rest, keep your
feet up to keep the swelling in your legs down.
7. Stop smoking- it causes the blood vessels in your body, including those in your heart, to constrict (narrow). This will make the symptoms
of your heart failure worse. It’s never too late to stop smoking, and stopping will be beneficial for your heart.
3. Make a drug study on Digoxin including the nursing consideration.

DRUG NAME MECHANISM OF ACTION RATIONALE ADVERSE EFFECT NURSING

CONSIDERATION

GENERIC NAME:  Increases the force of  Digoxin helps *CNS: fatigue, headache, * Monitor apical pulse
Digoxin myocardial contraction make the heart weakness for 1 full minute before
 Prolongs refractory beat stronger *EENT: blurred vision, yellow administering.
BRAND NAME: period of AV node and with a vision Withhold dose and
Lanoxin, Digitek, Lanoxin  Decrease conduction more regular *CV: arrythmias, bradycardia, notify physician if pulse
through the SA and AV rhythm. ECG changes rate <60 bpm in adult.
CLASSIFICATION: nodes *GI: anorexia, nausea, vomiting,
Antiarrhythmics,  Digoxin is used diarrhea * Monitor blood
inotropics Therapeutic Effect: to treat heart *Endo: gynecomastia pressure periodically in
 Increased cardiac failure. *Hemat: thrombocytopenia patients receiving IV
ADMINISTRATION: output (positive digoxin.
Injectable inotropic effect) and  Digoxin is also
route slowing of the heart used to treat *Monitor ECG
rate (negative atrial throughout IV
chronotropic effect) fibrillation, a administration and
heart rhythm periodically during
disorder of the therapy. Notify
atria (the upper physician or health
chambers of care professional if
the heart that bradycardia or new
allow blood to arrythmias occur.
flow into the
heart). *Observe IV site for
redness or infiltration;
extravasation can lead
to tissue irritation and
sloughing.

4. Give 6 objectives with interventions (for each objective) in the management of CHF.
OBJECTIVE
1. Decrease Cardiac Output
2. Promote adequate breathing
3. Manage blood pressure
4. Maintain required daily weight
5. Alleviate pain and fatigue
NURSING INTERVENTION
 Measure oxygen saturation with
pulse oximetry
 Monitor Vital signs
 Check for chest pain
 Take a chest x-ray
 Oxygen therapy
 Position the patient in semi-fowler
 Monitor blood pressure
 Low-sodium diet
 Check daily weight
 Document I & O
 Monitor vital signs
*Monitor I&O and daily
weights.
RATIONALE
 Changes in oxygen saturation is an
early sign of decreased cardiac
output
 To faster attend the needs of patient
if abnormal vital signs are present
 To prevent from heart attack
 X-ray images may show fluid buildup
in the lungs or an enlarged heart
 Oxygen therapy increases the
amount of oxygen sent to your
body's tissues. This helps reduce your
heart's workload.
 To promote the expansion of the
lungs
 To prevent other complication
especially heart attack
 It helps control symptoms of heart
failure and prevent other heart
problems.
 Obesity can increase the risk for
heart disease.
 To check if the patient’s liquid intake
is considerately equal to the output.
It is also an indication to check for
edema.
 Indication if the changes are
abnormal like respiratory rate that
made the patient experienced
difficulty of breathing.
  Limit activities  To not put more workload in the
heart that causes fatigue.
6. Reduce stress  Establish rapport. Relaxation  To not cause strain in the heart,
technique. which creates a higher risk for
cardiovascular disease.
 Adequate sleep  To promote productivity.