Question:

In order to be able and effective in clinical decision making, planning and execution in a variety situation that reflect the complexity of today’s health care environment and challenge, it is important to apply and integrate the key NMBA Registered nurses Standards for Nursing Practice and National Safety and Quality Health Service Standards.2.

Knowledge of anatomy, biology and pathophysiology can be used to support evidence-based decision making in a variety situations.3.

Demonstrate the ability to use clinical reasoning and make clinical decisions in order to provide safe, quality and person-centred healthcare throughout one’s life.4.

Communicate and collaborate effectively with family members and consumers by acquiring knowledge and skills.5.

Take time to reflect on the care provided and clinical placement. You can use feedback from many sources to find opportunities to improve your practice.

Answer to Question: NSB231 Integrated Nursing Practice 2

Heart failure can be defined as a medical condition in the which the heart stops pumping blood as normal because of structural and functional impairments in heart filling, ejection and replacement of blood. Rich, 2007,

This article describes the treatment of a 72year-old man with acute heart failure.

He complained of dyspnea as well as a feeling of being suffocating.

In the last few weeks, he has been experiencing difficulty walking and getting into the shower.

He has had swelling in his feet over the last few weeks. This is a clear indication of peripheral edema, which was confirmed by examination.

His auscultation also shows extensive course crackles. This could be a sign of a problem within his respiratory system.

Giovanni’s results from X-rays revealed an increase in his cardiothoracic proportion with white patches and Kerly B line areas in the lower parts.

An increase of the endo thoracic number could indicate pulmonary failure.

This paper examines two signs of heart problems. Each one has two options for nursing management.Dyspnea

Heart failure is usually associated to difficulty breathing.

Diastolic pressure, which is the period when blood pressure rises during heart failure, is also known as.

The relaxation period.

The blood pressure increases, pushing blood into vessels that pump blood back into the heart.

This causes fluid to leak into the lungs.

A weakened ability to breathe is caused by the presence of too much fluid in the lungs.

The accumulated fluid acts to prevent oxygen diffusion by acting as a physical block.

There are many ways to treat dyspnea.

These are the most important dyspnea management plan. (Yancy et al., 2013)

Drug Administration Such as Captopril

Captopril

Captopril was used in the management of dyspnea. This is because it has been proven effective as a long term therapy for heart failure-related dyspnea (Remme & Swedberg 2011).

Mode of Action

Converts enzyme inhibitors and blocks the production of angiotensin I, a potent inhibitor, and so results in a decrease arterial resistance. The angiotensin-converting enzyme is a zinc metalloprotease.

It works by releasing the angiotensin-converting enzyme (Zinc Metalloprotease) by cutting off angiotensin I’s binding to peptides.

The zinc atom in the active site is catalytic and activates the water molecule, which takes part in the hydrolysis.

Captopril prevents the zinc atom from being bonded to its thiol functions by blocking its vacant coordination (Rich, 2007).

Indications

This drug is used to treat hypertension.

Captopril is also used for heart failure and secondary prevention in the event of myocardial ischemia.

Reduce blood vessel resistance to lower the pulmonary pressure and thus reduce fluid leakage from the lungs.Dose

Captopril tablets are available in scored tablet sizes of 12.5 mg to 100 mg.

An initial dose of 25 mgs is administered orally once daily.

To maintain a good response, 50 milligrams are administered orally every day for not less that two weeks.

Captopril’s maximum dose is 450mg per day.

Many patients have enough response to take 50 or 100 mgs orally threex a days (Remme & Swedberg 2011).

Adverse Drug Side Effects and Prevention

The most common side effect of captopril are: tickly; rashes or other skin disorders like itching sores, redness, sensitivity to sunlight, and itching.

Angioneurotic fluid accumulation can also occur around the lips, mouth, chin, or cheeks.

Sometimes, captopril can cause low blood pressure and dizziness.

Dose escalation is possible to reduce side effects (Rich 2007,

Drug Interactions

Naloxone is a way to reduce captopril’s effects.

It is important for nurses to ensure that these two drugs do not go together.

A patient who is also taking naloxone and captopril will not have a good therapeutic response. Patients may become more ill.

Evaluation

It is the nurse’s responsibility to ensure consistency in drug administration and the proper dosages are given.

These efforts should aim to ensure that the treatment plan is successful.

The nurse is responsible for the evaluation of the patient’s medical response following drug administration.

To check for fluids in the lungs, a nurse can perform a physical examination.

The patient’s breathing patterns can also be checked (Remme, Swedberg 2011).

Oxygenation

The oxygen administration has the goal of metered enriching inhaled air with oxygen. It also increases the partial pressure of oxygen in the arterial blood.

It is essential to determine the actual values.

To determine the true values?in the blood, and to adapt the therapy with a blood gas analysis

Oxygenation should be considered if the patient is hypoxemic.

If the symptoms are caused by oxygen deficiency (acute shortness or exercise-related shortness), weakness, (daily), fatigue, cyanosis and other conditions, oxygen therapy can be used.

After partial removal or latent hypoxia, oxygen is used postoperatively (Sullivan et.al., 2008).

In the case of acute dyspnea, oxygen remains the most popular treatment. However, it is only an adjunct therapy.

O2 is often used to treat dyspnea. However, there are wide variations in PaO2 that are required to stimulate a respiratory response to hypoxia.

Hypoxia causes tissues to be devoid of oxygen sources that are essential for the normal functioning of their cells.

These tissues also have carbon dioxide.

Body tissues are extremely sensitive to high levels of partial carbon dioxide (Sullivan et.al. 2008).

The nasal probe, nasal glasses or a face mask can all be used to administer oxygen.

The nasal probe works better than the mask because it impedes communication.

A bottle can contain the oxygen in liquid form, or an extractor which extracts O2 out of the ambient air.

A home extractor is the most practical system due to its small size, mobility and non-flammable nature.

However, it can only produce low flow rates and is noisy.

For higher requirements, bottles are recommended (Rich, 2007).

A nurse can start oxygen therapy for a patient in order to allow him to attain a respiratory oxygen saturation (between 95 and 98%).

It is important to administer oxygen therapy immediately in emergencies.

It is important to keep the environment clean and free from contamination.

To avoid contamination, each patient will require a new tubing system.

Patients receiving oxygen therapy should be given special attention.

Monitoring and documentation include monitoring the patient’s breathing, pulse, blood pressure, consciousness, skin (cyanosis or pressure points), nasal and mouth mucosa, oxygen dosage, probe position, and the amount distilled water.

In order to assess whether the patient is responding to oxygenation, nurses should monitor these factors.

Nurses should be available to the patient when oxygen therapy is required (Sullivan et.al. 2008).Pitting Edema

Heart failure can lead to kidney damage and impaired ability to properly dispose of water and sodium.

Due to a decreased blood flow from your heart, the kidney receives fewer fluids.

This results in an increase in body water retention.

Edema occurs when this water builds up in the body.

Edema manifests as swelling in the legs that causes difficulty in getting on shores.

Pitting edema can also occur. If a nurse applies pressure to any part of the leg, a pit forms that takes a while to resolve (Remme& Swedberg 2011).

Pitting edema can be caused by a reduction in blood flow from the heart. This causes the blood returning to it through the veins back up.

The use of diuretic medication and the implementation of specific physical activities designed to reduce water accumulation can help relieve edema.

Furosemide can be used as a diuretic.Furosemide

Mode of Action

Furosemide comes from the class of abrasion durites.

A grinding diuretic is used to remove large amounts tissue fluid. This happens by inhibiting a transport proteins (the Na-K-2Cl Co-transporter) located in the ascending portion of the Henle Loop.

It is possible to excrete up to 50 liters of drug per day via intravenous administration.

It is a diuretic agent (Shiraishi. et. al., 2016).

Clinical Indications

Acceptable indications are hypertension, ascites (including cerebral edema), due to cardiac insufficiency, liver, kidney or burns, as well as threatened renal failure.

Furosemide may also be used to remove excess potassium from hyperkalemia.

Furosemide, which is also used in sports, is used to mask any doping agents that may have been removed from the body. (Shiraishi and al., 2016).Pharmacokinetics

Furosemide can also be given intramuscularly or orally.

The oral drug bioavailability for Furosemide is between 43-65 percent.

The drug undergoes liver metabolism and is excreted by the kidneys, liver and feces.

Adverse Drug Side Effects: Prevention and Management

Furosemide has major side effects including postural hypotension (ringing in the ears), and photosensitivity.

A nurse should monitor the patient closely, especially when he’s sleeping and sitting. This will prevent postural hypotension.

Remme & Swedberg (2011) warn that the patient should not stay in the sun too long after receiving the drug.

Contraindications

The following conditions should be avoided:

-Allergy for sulfonamides

-Urinary retention resulting from significant obstruction of your urinary tract

-Dehydration (especially among the elderly);-Hepatic encephalopathy;-breastfeeding.

Drug interactions

Furosemide may cause kidney damage when combined with non-steroid antiinflammatory medications, such as e.g. aspirin.

Aspirin can also cause cardiac toxicity if taken concurrently with antiarrhythmic drugs.

A nurse has a duty not to administer these drugs concurrently. This could cause complications for patient treatment plans (Thom & Kannel 2007.

Precautions

Patients at risk for acidosis are not advised to take this medicine.

For diabetics, and for older patients, it is vital to perform a renal and liver evaluation.

A regular monitoring of serum potassium is also important.

A nurse can actively participate in the ongoing monitoring of the hepatic or renal function of the patient, regardless of his/her age.

Renal function monitoring is done by measuring creatinine levels and comparing their elimination rates (Remme, Swedberg (2011)).

Evaluation Of Use

You can evaluate the efficacy of furosemide by measuring the urine output over a certain period.

The nurse will ask the patient if they would like to measure the volume of urine that was produced.Patient Lifestyle Management

This is an area in which the nurse is involved in patient care.

To ensure the best outcome for heart failure patients, a nurse plays a vital role in advising them on their lifestyle.

The patient should be informed about the dangers of smoking and how it affects his health.

Smoking can lead to worsening of the disease, so it is imperative that patients are urged not to smoke.

Long-term smokers have been shown to be closely linked to lung problems. Therefore, pulmonary edema combined with long-term smoking could have been the primary cause of his difficulty in breath (Yancy et.al. 2013, 2013).

A nurse can advise patients to do light exercises. Being physically active will decrease the patient’s heart workload, and allow it to beat more efficiently.

The nurse should also advise patients on which exercises they should be doing. Strenuous exercises can cause damage to the heart and cause severe pain.

A suitable program of low intensity exercises can be offered to help with this.

A diet plan should be discussed with the patient.

It is recommended that patients eat foods with low amounts of fats and salt.

Consuming foods high in salts can lead to an increase in body salt concentration, which may cause fluid accumulation and edema.

The nurse should reduce fluid intake.

Patient education is a positive way to help patients understand their condition and encourage them to take responsibility for their own management.

Also, weight management should be taken into consideration. The patient should not be encouraged to eat unhealthy foods with high fatty contents.

A high-level nurse intervention is required in order to manage a patient with cardiac failure.

A nurse plays an important role in the care management of a patient’s health. This includes their independent efforts to offer advice to patients and collaborating with doctors in administering the prescribed drugs.

They make sure the medication is administered in the prescribed dose and at the right time.

They are responsible for monitoring the drug’s effects during therapy.

Nurses support patients and should be closely linked with their patients.

While the nurse’s responsibility in patient care should end with discharge, it should also include monitoring the patient to make sure they are following the plan.

Positive patient outcomes can be easily achieved when nurses perform their duties well (Thom & Kannel (2007)

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