nursing intervention for acute heart failure...

[angel008]

hi...doing an assignment need 3 priority interventions for my pt who has acute heart failure.

my 1st intervention is pharmacological....by med. officer...

and need 2 nursing ones....

pt has left side heart failure

[Daytonite, BSN, RN]

Is it necessarily wrong though? I used to include the meds in my care plans as well as monitoring for s.e. of those meds. I was never told it was wrong. Meds are a major part of nursing and help complete the clinical picture. Don't you think?

No, it's not wrong, but it makes no sense to quibble over the choice of nursing interventions when it sounds to me as if you don't understand the importance of why you are doing them. If you knew what acute heart failure was and its symptoms I don't believe your first intervention would be to give the patient medications. Look up this medical condition and its signs and symptoms. Is pharmacology the appropriate first choice for nursing interventions? Perhaps some other nursing interventions need to be considered before reaching for pills and medications to make this patient more comfortable. Think about the ABCs.

[meluhn]

No, it's not wrong, but it makes no sense to quibble over the choice of nursing interventions when it sounds to me as if you don't understand the importance of why you are doing them. If you knew what acute heart failure was and its symptoms I don't believe your first intervention would be to give the patient medications. Look up this medical condition and its signs and symptoms. Is pharmacology the appropriate first choice for nursing interventions? Perhaps some other nursing interventions need to be considered before reaching for pills and medications to make this patient more comfortable. Think about the ABCs.

I do understand chf (read previous posts) and I wasn't quibbling, just clarifying. And I must disagree, lasix would be one of the first things you would do in an acute situation. You can sit the pt up and give o2 but the pulmonary edema is not going away on its own. I dont want to argue about this but dont tell me I don't know what I am talking about. I respectfully asked you a question, that is all.

We are talking about a pt in acute chf that can't breath. The op asked for priority nsg dx for acute chf, I dont think teaching and giving am care is even appropriate let alone a priority if someone can't breath.

[Daytonite, BSN, RN]

i do understand chf (read previous posts) and i wasn't quibbling, just clarifying. and i must disagree, lasix would be one of the first things you would do in an acute situation. you can sit the pt up and give o2 but the pulmonary edema is not going away on its own. i dont want to argue about this but dont tell me i don't know what i am talking about. i respectfully asked you a question, that is all.

we are talking about a pt in acute chf that can't breath. the op asked for priority nsg dx for acute chf, i dont think teaching and giving am care is even appropriate let alone a priority if someone can't breath.

why are you getting so defensive? maybe some of your own advice should be observed and you should read previous posts. . .(1) i never said you didn't know what you were talking about. (2) you never identified the acute heart failure patient as being someone in acute chf that can't breathe. (3) the op did not ask for priority diagnoses for a nursing diagnosis of acute chf, but for nursing diagnoses for left-sided heart failure. you were the one who introduced the term chf which confused the entire discussion when the op clearly used the term left sided failure. and, (4) i answered your question i'm sorry you didn't like my answer.

this is a student forum and the answers for students have to come from a rational and academic point of view so they understand why things are being done. your responses sound like someone who has been working in the clinical area and treating heart failure patients for some time. however, a student has to break the process down into a step-by-step process and rationalize each step.

the pathophysiology here is that the left ventricle has enlarged and the tissue of the heart has become stretched. as a result of this the patient will have ineffective left ventricular contractions, the ability of the left ventricle fails, cardiac output decreases, blood begins to back up into the left atrium and causing blood to back up into the lungs. as things progress to pulmonary edema the pulmonary circulation becomes engorged and the fluids overrun the systemic circulation so that the right ventricle begins to become stressed as it has to pump against greater pulmonary vascular resistance and left ventricular pressure. the progressive signs and symptoms are:

• fatigue
  
• an elevated heart rate
  
• pale, cool skin
  
• tingling sensation in the extremities
  
• arrhythmias
  
• dyspnea on exertion
  
• confusion
  
• dizziness
  
• orthostatic hypotension
  
• decreased peripheral pulses and pulse pressure
  
• cyanosis
  
• an s3 gallop
  
• coughing
  
• hemoptysis
  
• subclavian retractions during respirations
  
• crackles in the lungs which will progress to decreased breath sounds
  
• tachypnea
  
• orthopnea
  

when i talk about nursing interventions i am talking about what nursing can do independently of a doctor. diuretics for the pulmonary congestion require a doctor's order and is a collaborative intervention. ace inhibitors and vasodilators to dilate the blood vessels and decrease systemic vascular resistance require a doctor's order. vasodilators can also help to increase cardiac output, but require a doctor's order. what if there is no doctor in the immediate area? what can a student do who stands before a dyspneic patient when there is no doctor immediately available to order medication? they target the symptoms the patient is having. . .

• put the patient in fowler's position (head of bed elevated 45 degrees)
  
• give supplemental oxygen
  
• start cardiac monitoring
  
• get a set of vital signs
  
• assess the heart and lungs
  
• do a mental status exam
  
• apply antiembolism stockings and assess for dvt
  
• encourage the patient to rest
  

the nursing diagnoses that apply. . .

• decreased cardiac output
  
• activity intolerance
  
• impaired gas exchange
  
• ineffective tissue perfusion, cardiopulmonary
  
• ineffective airway clearance
  
• ineffective breathing pattern
  
• excess fluid volume
  
• fatigue
  

this is the kind of thinking process that is expected to go into answering the question posed by the op by instructors. if i missed something please add it. my references were pathophysiology: a 2-in-1 reference for nurses which has an excellent explanation of left and right sided heart failure and nurse's 5-minute clinical consult: diseases which i used to verify the nursing interventions. i answer these kinds of questions all the time for students in an effort to teach the critical thinking skill.