Nursing Intervention Case Study In Cardiac Patient

For this essay, select either Essay Case Option 1 (the  paediatric case) or Essay Case Option 2 (the adult  case). Review your chosen case and the clinical  documents. Using the clinical reasoning cycle you are  required to assess, plan, implement and evaluate your  care for the patient. After identifying the relevant  assessment data you must identify two (2) priority  problems for your patient. For each priority problem  identified, list two (2) nursing interventions  

(collaborative/independent) linking to your research of  the literature. Include a one to two line rationale for each  intervention. Evaluation of your care is essential.

INTRODUCTION

As most of heart failure patients are elder adults, heart failure is a geriatric syndrome. Dysfunction of heart is also a cardiac syndrome compounded by difficult and rapidly developing pathogenesis and healing management. Among older adults heart dysfunction is the leading cause of hospitalization and such heart failure patients are managed by generalist physicians. In addition, in contrast to other cardiovascular disorders, the heart breakdown is a clinical diagnosis that would be carried out at the bedside and the conventional evidence-based therapy for heart stop-working can simply be applied by generalist physicians. Because of the nature of treatment is governed by multiple co-morbidities and polypharmacy, the diagnosis and management of heart stop working with the elderly may be complicated (Stellenberg, Kinder, & Bruce, 2014).

Giovanni is a 72 year age old person with chronic heart dysfunction who has admitted in Emergency at 3 AM complaining of sensation of suffocating and shortness of breath. Although he sat up for 3 times, dyspnoea is not relieved. He feel difficult to walk in bare foot in home and find himself increased breathlessness. His foot became swollen. He is unable to leave his existing habits such as smoking, exercise and his dietary pattern. On assessment, Mr. Giovanni found to have HR 115/minute, normal ECG, RR 26/minute, BP 118/60 and T 36.9 C. The chest x-ray of Mr. Giovanni reveals white patchy spots with Kerly B lines in the lower lobes as well as enlarged cardiothoracic ratio. He is diagnosed with chronic heart failure.

Main Body

First identified nursing problem

The nurse found to have certain difficulties in  analyzing and interpreting the results in comparison with the given lab reference values as well as prioritize the patient that require immediate care of the doctor. 

The fundamental duty of the nurse to monitor the entire diagnostic methods were carried out and the outcomes are made accessible to the physician for elucidation and accordingly modify the treatment. The cardio graph, chest X-rays as well as blood assessments are routine diagnostic tests. In order to rule out the pulmonary congestion and the enlargement of the heart, chest x-ray is recommended particularly for the patients with heart breakdown. Similarly, for detecting the abnormalities of heart contractions, the ECG would indicate them through its deviant ECG graphs. So, for right startup treatment, the nurse faces certain difficulties in interpreting the available results.

Full Blood Count (FBC) as well as Urea and Electrolytes (U&E) are the most recommended blood tests for Mr. Giovanni with chronic heart breakdown. The FBC is carried out for verifying the total count of RBCs to assure the oxygen transporting capacity of the body versus hypoxia that is most common with Mr. Giovanni. In order to rule out least immunity and the potential threat of infection due to low metabolism, which is an inherent feature of heart breakdown, white blood cells are monitored. The Urea is observed to eliminate the potential storage of urea and some metabolic wastes due to less venous return, a possible factor causing metabolic acidosis. Electrolytes are controlled to eradicate the imbalances of extracellular as well as intracellular electrolytes. The interpretation issue faced by the nurse migh lead to the risk of heart attack and arrhythmia as the heart is already in breakdown position (Paul, 2013). 

Relating first identified nursing problem with patient physiology

The prescriptions and justifications of the diagnostic examinations for Mr. Giovanni suffering from a chronic heart breakdown in clinical surroundings are under the command of the nurse. As far as the independent nursing intervention is concerned, the patient must be kept abreast of the fact that the heart breakdown would lead to general slow circulation, dysponea and low systemic output. As such, the symptoms like dizziness, light-headedness, palpitations, weakness, coldness and shortness of breath may be experienced by the patient. He is, hence, required to record the formation of oedema, breathing complexity while at static position and needs to make him warm. Escalation of the signs and symptoms must be communicated to the local health care facility. Risky lifestyle activities like tobacco smoking, alcohol consumption as well as performing strenuous functions such as physical execrises and emotional upsets may be refrained from Mr. Giovanni. Significantly, the dietary intake for the patient down with chronic heart dysfunction must be discussed in carrying out the independent nursing intervention program. In this respect, the local food items meeting the needs for a cardiac food must be escalated and the family members must be given in details of preparing methods of the meal using the foodstuffs available in the household. Most importantly, restriction of salt to avoid oedema must be emphasized (Smelter, Bare, Hinkle, & Cheever, 2010). High calorie rich and nutritious diet must be advised to the patient so as to be thriving and livelihood.  Intervals of medication administered and medication dosages must be explained with complete manifestation. The patient must be convinced in adhering to the treatment group, shunning away from taking medications and to follow up punctual treatments. The family members must be included in entire phases of health education for supporting the patient at home. Recording taken on care management controls undertaken for the patient is an inherent part of the clinical care program.