CHF is the failure of the heart to pump blood effectively to meet the metabolic demands. Because of that failure there is excessive amounts of fluid in the heart,lung and tissues. The left sided failure the blood will back up into the lungs causing pulmonary edema manifestations. When the right side of the heart fails blood backs up into the venous and portal system manifestations. Signs and symptoms of CHF are dyspnea, orthopnea,weight gain,pulmonary edema, distended neck veins, crackles. The nurse formulates a plan of care for a patient with left sided CHF.An appropriate nursing diagnosis would be an alteration in gas exchange secondary to capillary hydrostatic pressure. The patient is placed on low sodium diet by the doctor. 02 at 2liter nasal cannula and morphine 2mg IV Q3hours prn pain.
(1)Why did the doctor place patient on low sodium diet?.
(A) Because patient doesn’t want sodium.
(B) Fluid restriction is is the best approach.
(C) Patient is overweight due to CHF.
(D) Patient came into the hospital due to congestive heart failure.Since the heart is not pumping well extra sodium intake will lead to fluid retention.
Correct answer D.
(2)What is the rationale for potassium supplements?.
(A) Patient is on lasix and lasix depletes potassium.
(B) Our body needs electrolytes.
(C )Potassium is good for you.
(D)Patient should also be on oxygen at 2liter nasal cannula.
Correct answer A.
Rationale: Lasix is not a potassium sparing diuretics. It depletes potassium.So potssium supplement is given as ordered by the doctor. Potassium is an important electrolyte of the body. But if the patient is a dialysis patient.The nurse should call the doctor so that it can be taken care of during dialysis.
(3)The nurse is preparing to begin a dopamine infusion on a patient. Before starting the infusion, the nurse should?.
(A) Should assess IV patency.
(B) Assess if the patient can swallow food.
(C ) Check the doctor orders again.
(D) Check patient room number again.
Correct answer A.
Rationale: It is very important to assess the IV patency.This is to make sure that IV is properly placed and the fluid will be delivered into the vein as planned. The nurse should check for swelling, pain or resistance which might signify blockage. As a nurse you want the dopamine to be delivered without infiltration. Dopamine is use to treat and improve low cardiac output, low blood pressure and increased blood flow to the kidney. Sometimes it can be use with other medications.
(4) During shift change at 07am while the nurses were giving reports.The patient in room 3211609 is scheduled for cardiac stress test at 12noon.He asked the CNA if he can get breakfast before NPO since he is very hungry. The CNA notified the Registered nurse.Which of the following should the nurse do?.
(A) Provide Creamy wheat, bread and fried chicken.
(B) Coffee,cereal, omelets.
(C) Patient is NPO for cardiac test.
(D)Provide patient with light meal of cereal,juice,and milk.
Correct answer D.
Rationale:D is the correct answer.Patient should be NPO 2 to 3 hours before procedure. A,B,C are all wrong.Patient doesn’t need a heavy meal before cardiac stress test.Coffee has caffeine and that can cause Sympathetic nervous stimulation thereby increasing heart rate and blood pressure.
HEART FAILURE CORE MEASURES.
(Please strictly follow your hospital policy and procedures)
It is very important to give good Discharge Teaching to your patient with emphasis on :
Medication administration as ordered.Take your medications as ordered and as scheduled. If your medication is scheduled for 09am,take it at the time that it is scheduled.
Maintain Health heart diet.Low sodium intake.
Encourage patient to weigh self at least three times a week.
If condition worsen call your doctor or report to emergency room immediately.
Mild exercise is needed daily.
And Follow up with your doctor Appointment as scheduled.
Also patient is given evaluation of ejection fraction less than 40% based on the Echocardiogram by the doctor.
ACE (Angiotensin- converting enzymes)inhibitor given to patient for ejection fraction less than 40%.
Please follow doctor orders.This is very important.