Woman with History of Hypertension, Chronic Heart Failure, and Sleep Apnea

Woman with History of Hypertension, Chronic Heart Failure, and Sleep Apnea

Woman with History of Hypertension, Chronic Heart Failure, and Sleep Apnea

Woman with History of Hypertension, Chronic Heart Failure, and Sleep Apnea

NRS 410 V Mrs. J., age 63, has a history of hypertension, chronic heart failure, and sleep apnea. She has refused to quit smoking two packs of cigarettes per day for the past 40 years.

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Mrs. J., age 63, has a history of hypertension, chronic heart failure, and sleep apnea. She has refused to quit smoking two packs of cigarettes per day for the past 40 years. She got the flu three days ago, with fever, pharyngitis, and malaise. For the past four days, she has not taken her antihypertensive or heart failure medications. She was admitted to the hospital’s intensive care unit today with acute decompensated heart failure.
Subjective Information
1. Is extremely worried and wonders if she will die.
2. Denies feeling pain but claims she can’t get enough air.
3. She claims that her heart is “running away.”
4. Reports that she is so exhausted that she is unable to eat or drink on her own.
Data that is objective
1. 175 cm in height; 95.5 kg in weight
2. Vital signs: T 37.6 degrees Celsius, 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; preliminary cardiac monitoring shows a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles, decreased breath sounds in the right lower lobe, coughing up frothy blood-tinged sputum 82 percent SpO2
5. Gastrointestinal: BS present, with hepatomegaly 4 cm below the costal margin.
Questions for Critical Thinking
What nursing interventions are appropriate for Mrs. J. during her hospitalization? Mrs. J. begins drug therapy to control her symptoms. What is the rationale for administering each of the medications listed below?
1. intravenous furosemide (Lasix)
2nd. Enalapril (Vasotec)
3. methylprednisolone (Lopressor)
4. morphine sulphate intravenous (Morphine)
Describe four cardiovascular conditions that can lead to heart failure and what medical/nursing interventions can be used to prevent the development of heart failure in each condition.

Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients, taking into account that most mature adults take at least six prescription medications. Give a rationale for each intervention you recommend.

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