dilated cardiomyopathy case study

Dilated CardiomyopathyCONGESTIVE HEART FAILURE

BSN-3F

General Objective: The general objectives for the conduction of this case study are for students to incorporate concepts and enhanced knowledge in Medical Surgical Nursing to apply the appropriate nursing management for clients with Dilated Cardiomyopathy and Congestive Heart. This study aims to improve nursing interventions that can possibly help our patient in understanding and maintaining special needs. At the same time, it allows the students to utilize the different attitudes that were instilled on them, such as on being respectful, patient and empathetic and improve the self-esteem by gaining knowledge and competency in handling future cases like these.

Specific Objectives:

At the end of the case presentation, this case study specifically aims to:

* Define Dilated Cardiomyopathy; Congestive Heart Failure accurately* Discuss briefly the causative factors that may have precipitated the onset of the condition* Discuss thoroughly the signs and symptoms manifested by patient* Discuss the different drugs; indications; mechanism of action, therapeutic effects, adverse effects and contraindications.

* Present accurately the condition of the patient* Acquire knowledge and understanding of the pathophysiology * Discuss the nursing care plan appropriate in providing care to alleviate the manifestation of the patient’s symptoms* Identify and provide the health teachings needed for the continuum of care* Use the nursing care plan as the framework of the patient’s care

Chief Complaint:

The patient came to the hospital complaining of difficulty of breathing. She asked to be brought to the facility because she felt something heavy is pressing on her chest, as she verbalized it, “parang may nakadagan sa didbdib ko”, and requested that she be administered oxygen because she is aware that the only way to alleviate the difficulty is through oxygen administration.

Chief Complaint: Pt’s Name: SL

Age: 70y/o

Sex: Female

Civil Status: Married

Birthday: May 14, 1940

Occupation: Homemaker

Religion: Roman Catholic

Ad Date: March 8, 2011

Ad Time: 1:43am

Institution: MCI 5th Floor

Diagnosis: Dilated

Cardiomyopathy; CHF

Nursing Health History

History of Present Illness:

One month PTA, the patient experienced difficulty of breathing, and was administered with oxygen to manage DOB. A day PTA, the patient experienced again DOB and verbalizes “parang may nakadagan sa akin, kaya ginising ko na ang anak ko para magpadala sa ospital” and was administered oxygen and according to her it was effective. Because of severe difficulty of breathing, the patient was prompted admission.

Past Medical History:

During childhood, the patient had chickenpox, mumps and measles and was given BCG, MMR and DPT as immunizations. She recalls no allergy to food, but previously had allergy to penicillin. The patient had been hospitalized before due to accident; she experienced 3rd degree burns when she was 35 years old; and was hospitalized twice, one during a complication in delivery and another when she got burned, and add to that her current hospitalization.

The family has a history of congenital heart defect. The patient’s mother died from it, and so is the

patient’s younger child. The patient’s father died of old age.

Family History of Illness:

Gordon’s Functional

Health Patterns

Health Perception and Health Management Pattern:

She admits to being sickly as she verbalized,“sickly na ako, wala na ako magawa sa buhay” but keeps herself healthy by avoiding all the things that are not necessary in her nutrition, such as salt and fats. The patient is aware of and understands her diagnosis. She is compliant to her medications. Her plan for faster recovery is to have more rest and take medicines on time.

Nutritional-Metabolic Pattern:

The patient likes to eat but only the ones that will not contribute to her illness or disease such as vegetables like blanched potatoes. The patient is restricted to 1 L of water per day. According to the patient, illness and being hospitalized doesn’t affect her appetite and nutritional intake at all as she has not lost her appetite.

24-Hour Recall Diet

Breakfast Low salt noodles ½ glass of water

LunchChicken with ampalaya and corn ½ glass of water

Dinner Malunggay vegetables

1 glass of water

Breakfast Bread and chicken ½ glass of water

Elimination Pattern:

The patient has no problem in urinating. She doesn’t feel any discomfort voiding. She had bowel movement once only yesterday and has no problem in defecation but still has not moved today. The client is discouraged to perform the valsalva’s maneuver that is why she is ordered to take laxative. She last urinated at 7:15 AM today prior to the interview and has not defecated yet that she was given Lactulose, a laxative so to lessen, if not, avoid valsalva’s maneuver.

Activity-Exercise Pattern:

The patient is able to perform ADL but the doctor advised her not to have any bathroom privileges. She doesn’t have any type of exercise. Shortness of breath is noted. Patient is able to move without assistance but needs the assistance to prevent any injury. Illness and hospitalization doesn’t affect her general mobility and self-care, and according to her, she can still take care of herself but stated that she had difficulty in moving around and experiencing sort of boredom.

Sleep-Rest Pattern:

The patient verbalizes that “kapag nagagalit ako at madami akong iniisip, hindi ako nakakatulog ng maayos.” She doesn’t drink any coffee or tea. No difficulty in falling asleep is noted. She feels rested after every sleep, according to her. No presence of snoring or sleepwalking. She has not used any sleeping aids, however she complains that “hindi naging dire-direcho ang tulog ko dahil sa ingay, madami akong iniisip at nagalit ako kagabi” during hospitalization.

Cognitive-Perceptual Pattern:

No sensory deficit is noted because the patient is aware of the time and date and understands what’s going on. No memory lapses, as well, is observed because she told us her life story beginning from high school with thorough detail. None observed with regard to long-term memory lapse. The patient understands instructions regarding her diagnosis. She doesn’t take any pain medications since the patient doesn’t experience any pain.

Self Perception & Self Concept

Pattern:She describes herself as a sickly person due to her current illness, but says that she can handle it. She still sees herself as a normal person and does not have any problem with her appearance. The hospitalization and illness does not have much effect on her self-concept but states that she has a bit of difficulty moving around.

Role Relationship Pattern:

She is a wife, a mother and a grandmother. She has no relationship problems with her families. Her grandchildren always drop by to check on her before going to school. She loves everyone in the family who is very supportive. Due to her illness and hospitalization, she misses her daily routine at home such as waking her grandchildren and embracing them.

Coping & StressTolerance Pattern:

She experiences usual stressors from her environment and during her stay in the hospital. Her only coping strategy is meditation and finds it very effective. However, she is a bit stressed with her stay in the hospital and anxious to go home.

Value Belief Pattern:

Her most important religious practice is praying. Her illness affects her religious practice because she states that she can’t read the bible. She strongly believes that God will help her and she has faith in HIM. She stays positive and prays that she will still be okay soon.

Physical

Assessment:

General Appearance:

We received the patient lying on bed awake with on-going IVF #2 PNSS 500 cc x 12º at 450 cc level, hooked @ L MCV, patent and infusing well. The body built of the patient is proportionate and coordinated. Her hygiene and grooming is clean and neat with no body odor or foul breath. However, there was an obvious sign of labored breathing. She has a responsive and cooperative affect and an understandable speech – conscious and coherent.

Vital Signs:

The patient’s vital statistics are normal with a body temperature of 36.6°C in the axillary; and has an irregular and thready pulse rate of 60 beats per minute. She has a regular but deep respiratory rate of 22 cycles per minute, and blood pressure of 110/70 mmHg in the lying position.

Skin:

The color of the skin is light and a little pallor but uniformly distributed; no edema, no lesions but has presence of flat nevi. It is a little dry and cool to touch and has a poor turgor. No clubbing or spooning is present but a 160° convex, smooth, and the color of the nails is pallor with more than 4 seconds of capillary refill time but intact surrounding tissue.

Head:

There is no presence of alopecia but the hair is not thick due to age. It is resilient and evenly distributed with no presence of infestations. Her head is normal in size and shape with smooth contours and symmetrical facial features. No presence of facial tremor can be seen.

Eyes:The eyebrows and the eyelashes are evenly distributed resting on the eyelid skin that is intact. The conjunctiva is smooth with no presence of edema, swelling or tenderness on the lacrimal gland. The corneas are transparent and smooth and responded to the reflex. The pupils are black, equal in size, equally round and responded to light and accommodation. Aside from being coordinated, there is no presence of extraocular movements.

Ears:The ears are mobile and firm and have symmetrical and uniform skin color of the pinna. No presence of cerumen or any discharge. The patient has a sluggish hearing acuity on whisper test.

Nose:

The external nose is symmetrical with a septum in the midline of the nasal cavity without any presence of tenderness.

Pharynx & Mouth:The symmetrical lips are moveable, soft, but not too moist, but smooth and pinkish in color. Her teeth are no longer complete which are resting on gums that are moist, firm and pinkish in color. The pinkish, smooth and moveable tongue is placed in the midline. And behind it is a smooth and light pink palate with the uvula in the midline. The tonsils and oropharynx are pink and smooth.

Neck:The neck muscles are equal in size but no longer have the full range of motion. No palpable lymph nodes. The trachea is placed in the midline with the thyroid gland not visible. The patient has a symmetrical but weak carotid pulse and has jugular veins that are visible.

Chest & Lungs:The breathing pattern is irregular, though with effort and some cracklings can be heard during auscultation of the left lung. The chest has costal angles that are less than 90° and symmetrical APL ratio 1:1. The spine is vertically aligned but leaning a little bit forward. She has decreased and asymmetric chest expansion during respiratory excursion. A resonance can be heard on percussion with crackles.

Heart:

There are pulsations and presence of heaves and thrills in the precordium with S1 louder at S2 at the base.

Abdomen:

The abdomen is unblemished, flat and symmetrical. There is no presence of tenderness during palpation. It is normoactive during auscultation and tympanic during percussion.

Back & Extremities:

The muscles are beginning to atrophy but equal in size on both sides of the body. They are no longer firm in tone. However, there is no presence of swelling or tenderness in the bone but. No deformities or swelling at joints aside from the broken and displaced left wrist which make its range of motion limited.

Summary of Findings

& Analysis:Overall, the patient’s condition looks normal at first glance but if observed objectively, the patient has difficulty breathing which is a manifestation of presence of crackles in the left lung, causing CHF.

Anatomy

&Physiolo

gy

TheHEART

CHF

NON-MODIFIABLE FACTORS

Genetics (family history-cardiomyopathy)

Decreased contractility (bradycardia 52 PR)

LV DILATATION HYPERTROPHY

LEFT SIDE HEART FAILURE

BACKFLOW OF BLOOD TO THE LUNGS

PULMONARY CONGESTION (+) CRACKLES, DOB and ORTHOPNEA

Clinical Findings:PallorCool, ashen skinCapillary refill of more than 4 secondsOrthopneaCrackles at left lungFatigued or labored breathing(+) Weakness(+) use of accessory muscle(+) Substernal retractionsRR – 25cpm (Tachypnea)

Laboratory&

Diagnostic

Study:

DIAGNOSTIC TEST AND DESCRIPTION

ALBUMIN

This test can help determine if a patient has liver disease or kidney disease, or if the body is not absorbing enough protein.

INDICATION AND CONTRAINDICATION

This test can help determine

if a patient has liver disease or kidney disease, or if the body is not absorbing enough protein.

CLIENT PREPARATION AND POST PROCEDURE INSTRUCTIONSALBUMIN

Avoid drugs that can increase albumin measurements includes anabolic steroids, growth hormone, and insulin. A blood sample is needed. The blood sample is placed in a machine called a centrifuge, which spins and separates the cells

from the liquid part of the blood (the serum).

CLIENT PREPARATION AND POST PROCEDURE INSTRUCTIONS

ALBUMIN

Avoid drugs that can increase albumin measurements includes anabolic steroids, growth hormone, and insulin.

A blood sample is needed. The blood sample is placed in a machine called a centrifuge, which spins and separates the cells from the liquid part of the blood (the serum).

NORMAL VALUES38-55 (g/dL)

RESULTS 35g/L

CLINICAL SIGNIFICANCENURSING IMPLICATIONS

Albumin, produced only in the liver, is the major plasma protein that circulates in the bloodstream. Albumin is essential for maintaining the osmotic pressure in the vascular system. A decrease in osmotic pressure due to a low albumin level allows fluid to leak out from the interstitial spaces into the peritoneal cavity. That is why; the patient has presence of crackles at left lung.

http://health.nytimes.com/health/guides/test/growth-hormone/overview.html

ProblemList

Actual:DIAGNOSES RANK JUSTIFICATION

Ineffective breathing pattern related to decreased oxygen supply secondary to pulmonary congestion as manifested by difficulty of breathing and increased RR of 25 cycles per minute

1 The first priority is focused on the actual problem of the patient which is difficulty of breathing

Impaired gas exchange related to excessive fluid in interstitial space in lungs secondary to left heart failure as manifested by fatigued breathing and crackles at left lung as auscultated

2 Next to airway is breathing. This nursing diagnosis should be implemented as well for the client to meet again effective breathing, since the client is experiencing fatigued breathing and has presence of crackles at the left lung as auscultated

Impaired gas exchange related to excessive fluid in interstitial space in lungs secondary to left heart failure as manifested by fatigued breathing and crackles at left lung as auscultated

2 Next to airway is breathing. This nursing diagnosis should be implemented as well for the client to meet again effective breathing, since the client is experiencing fatigued breathing and has presence of crackles at the left lung as auscultated

Ineffective tissue perfusion: peripheral related to impaired circulation secondary to left heart failure as evidenced by pallor skin and capillary refill more than 4 seconds

3 Inadequate oxygen in the circulation may interfere with the ability of the cells to transform into energy. It may result to respiratory/ventilation problems.

Ineffective tissue perfusion: peripheral related to impaired circulation secondary to left heart failure as evidenced by pallor skin and capillary refill more than 4 seconds

3 Inadequate oxygen in the circulation may interfere with the ability of the cells to transform into energy. It may result to respiratory/ventilation problems.

Potential:

DIAGNOSES RANKING JUSTIFICATIONRisk for fluid volume excess related compromised regulatory mechanism secondary to left heart failure

1 The patient had pulmonary congestion and experiencing crackles at the left lung which is indicative of presence of fluid.

Risk for injury related to decreased mobility

2 Since the client is experiencing body weakness which steady state occurs, any stressor that alters the ability of the cell or system to maintain optimal balance of its adjustments processes may lead to injury. Safety and security is next in Maslow’s Hierarchy of needs and is also important in preventing alteration in one’s functioning.

Risk for injury related to decreased mobility

2 Since the client is experiencing body weakness which steady state occurs, any stressor that alters the ability of the cell or system to maintain optimal balance of its adjustments processes may lead to injury. Safety and security is next in Maslow’s Hierarchy of needs and is also important in preventing alteration in one’s functioning.

Nursing Diagnos

is

Actual:

Ineffective breathing pattern related to decreased oxygen supply secondary to pulmonary congestion as manifested by difficulty of breathing and increased RR of 25 cycles per minuteImpaired gas exchange related to excessive fluid in interstitial space in lungs secondary to left heart failure as manifested by fatigued breathing and crackles at left lung as auscultatedIneffective tissue perfusion: peripheral related to impaired circulation secondary to left heart failure as evidenced by pallor skin and capillary refill less than 4 seconds

Psychological:Deficient diversional activity related to prolonged hospitalization as manifested by boredom

Potential:Risk for fluid volume excess related compromised regulatory mechanism secondary to left heart failureRisk for injury related to decreased mobility

ActualNursin

gCarePlan

ASSESSMENT Subjective:“Parang may nakadagan sa dibdib ko” as verbalized by the patient. Objective: (+) DOB (+)Fatigue (+) crackles, left lung Use of accessory muscles(sub-sternal retractions)

Tachypnea RR-25cpm

NURSING DIAGNOSIS Ineffective breathing pattern related to decreased oxygen supply secondary to pulmonary congestion as manifested by difficulty of breathing and increased RR of 25 cycles per minute

NURSING DIAGNOSIS Ineffective breathing pattern related to decreased oxygen supply secondary to pulmonary congestion as manifested by difficulty of breathing and increased RR of 25 cycles per minute

SCIENTIFIC EXPLANATION Dilated myocardiopathy - is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.

SCIENTIFIC EXPLANATION Dilated cardiomyopathy – is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.

http://en.wikipedia.org/wiki/Heart

PLANNING Short term goal: After 2 hours of nursing intervention the patient will be able to establish effective respiratory pattern. Expected outcome: (-) DOB Decrease RR to normal range

(12-20cpm) (-) use of accessory muscles

(sub-sternal retractions)

PLANNING Short term goal:After 2 hours of nursing intervention the patient will be able to establish effective respiratory pattern. Expected outcome: (-) DOB Decrease RR to normal range(12-20cpm)

(-) use of accessory muscles(sub-sternal retractions)

SELECTED INTERVENTION

Monitor the vital signs hourly as needed. Auscultate the chest to evaluate the presence of breath sounds.

Assist patient on semi-fowler’s position. Encourage deep breathing exercises.

Maintain calm attitude while dealing with patient. Assist patient in the use of relaxation techniques. Encourage adequate rest periods between activities.

Stress importance of good posture and effective use of accessory muscles.

Maintain calm and clean environment.

Administer oxygen as ordered.


Monitor the vital signs hourly as needed. Auscultate the chest to evaluate the presence of breath

sounds. Assist patient on semi-fowler’s position. Encourage deep breathing exercises. Maintain calm attitude while dealing with patient. Assist patient in the use of relaxation techniques. Encourage adequate rest periods between activities. Stress importance of good posture and effective use of

accessory muscles. Maintain calm and clean environment. Administer oxygen as ordered.

IMPLEMENTED INTERVENTIONS

Monitored the vital signs every hour.

Performed chest auscultation to evaluate the presence of breath sounds.

Assisted patient on semi-fowler’s position.

Encouraged deep breathing exercises.

Maintained calm attitude while dealing with patient.

Assisted patient with the use of relaxation techniques.

Encouraged adequate rest periods between activities.

Stressed importance of good posture and effective use of accessory muscles.

Maintained calm and clean environment.

Administration of O2 therapy as prescribed by the physician.


Monitored the vital signs every hour. Performed chest auscultation to evaluate the presence of

breath sounds. Assisted patient on semi-fowler’s position. Encouraged deep breathing exercises. Maintained calm attitude while dealing with patient. Assisted patient with the use of relaxation techniques. Encouraged adequate rest periods between activities. Stressed importance of good posture and effective use of

accessory muscles. Maintained calm and clean environment. Administration of O2 therapy as prescribed by the

physician.

EVALUATION Goal Met After 2 hours of nursing intervention the patient was able to attained effective respiratory pattern. (-)DOB (-) Crackle sound Maintained RR within normal range 20cpm (-) Use of accessory muscles


EVALUATION Goal Met After 2 hours of nursing intervention the patient was able to attained effective respiratory pattern. (-)DOB (-) Crackle sound Maintained RR within normal range 20cpm (-) Use of accessory muscles


ASSESSMENT Subjective:“Medyo ok naman na sya, pero medyo hirap pa din sa paghinga” as verbalized by the patient’s relative. Objective: DOB/SOB Lethargy Irritable Restlessness (+) Crackle sound at left lung as auscultated Use of accessory muscle(sub-sternal retractions) Tachypnea RR-25 cpm

NURSING DIAGNOSIS Impaired gas exchange related to excessive fluid in interstitial space in lungs secondary to left heart failure as manifested by fatigued breathing and crackles at left lung as auscultated.

NURSING DIAGNOSIS Impaired gas exchange related to excessive fluid in interstitial space in lungs secondary to left heart failure as manifested by fatigued breathing and crackles at left lung as auscultated.


SCIENTIFIC EXPLANATION Dilated cardiomyopathy – is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.


PLANNING Short term goal: After 2 hours of nursing intervention the patient will improve ventilation and adequate oxygenation Expected outcome: Maintain clear lung fields and remain free of signs and symptoms of respiratory distress. (-) crackles at left lung. RR within normal range of 12-20 cpm. Participate in treatment regimen (e.g., deep breathing) within level of ability.

PLANNING Short term goal:After 2 hours of nursing intervention the patient will improve ventilation and adequate oxygenation Expected outcome: Maintain clear lung fields and remain free of signs and

symptoms of respiratory distress. (-) crackles at left lung. RR within normal range of 12-20 cpm. Participate in treatment regimen (e.g., deep breathing)

within level of ability.


Monitor respiratory rate, depth and effort including use of accessory muscles and abnormal breathing patterns.

Auscultate breath sounds every 1 to 2 hours.

Monitor client’s behavior and mental status for the onset of restlessness and lethargy.

Assist client in semi-fowler’s position.

Reposition the client every 2 hours.

Encourage client to practice deep and pursed-lip breathing exercise.

Encourage client to have adequate rest periods.


Monitor respiratory rate, depth and effort including use of accessory muscles and abnormal breathing patterns.

Auscultate breath sounds every 1 to 2 hours. Monitor client’s behavior and mental status for the onset

of restlessness and lethargy. Assist client in semi-fowler’s position. Reposition the client every 2 hours. Encourage client to practice deep and pursed-lip breathing

exercise. Encourage client to have adequate rest periods.


Monitored respiratory rate, depth and effort including use of accessory muscles and abnormal breathing patterns.

Auscultated breath sounds every 1 to 2 hours.

Monitored client’s behavior and mental status for the onset of restlessness and lethargy.

Assisted client in semi-fowler’s position.

Repositioned the client every 2 hours.

Encouraged client to practice deep and pursed-lip breathing exercise.

Provided rest and minimized fatigue.


Monitored respiratory rate, depth and effort including use of accessory muscles and abnormal breathing patterns.

Auscultated breath sounds every 1 to 2 hours. Monitored client’s behavior and mental status for the

onset of restlessness and lethargy. Assisted client in semi-fowler’s position. Repositioned the client every 2 hours. Encouraged client to practice deep and pursed-lip

breathing exercise. Provided rest and minimized fatigue.

EVALUATION Goal met After 2 hours of nursing intervention the patient was improve ventilation and adequate oxygenation. Maintained clear lung fields and remained free of signs and symptoms of respiratory distress.

(-) Crackles at left lung.

RR within normal range 20 cpm.

Participated in treatment regimen (e.g., deep breathing) within level of ability.

EVALUATION Goal met After 2 hours of nursing intervention the patient was improve ventilation and adequate oxygenation. Maintained clear lung fields and remained free of signs

and symptoms of respiratory distress. (-) Crackles at left lung. RR within normal range 20 cpm. Participated in treatment regimen (e.g., deep breathing)

within level of ability.

ASSESSMENT Subjective:“Namumutla siya” as verbalized by the patient’s relative Objective: (+) DOB (+) Pallor skin Capillary refill >4 seconds Use of accessory muscles(sub-sternal retractions) Tachypnea RR:25cpm

NURSING DIAGNOSIS Ineffective tissue perfusion: peripheral related to impaired circulation secondary to left heart failure as evidenced by pallor skin and capillary refill more than 4 seconds

NURSING DIAGNOSIS Ineffective tissue perfusion: peripheral related to impaired circulation secondary to left heart failure as evidenced by pallor skin and capillary refill more than 4 seconds


SCIENTIFIC EXPLANATION

Dilated cardiomyopathy – is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.


PLANNING Short term goal: After 2 hours of nursing intervention the patient will be able to improve tissue perfusion Expected Outcome: Normalize capillary refill (1-3 seconds)

Normalize the color of the skin

PLANNING Short term goal: After 2 hours of nursing intervention the patient will be able to improve tissue perfusion Expected Outcome: Normalize capillary refill (1-3 seconds) Normalize the color of the skin

SELECTED INTERVENTION Monitor the vital signs and note for any changes.

Assess for skin coolness and color.

Position on semi-fowler’s position.

Encourage deep breathing exercises.

Encourage adequate rest periods between activities.

Measure capillary refill and palpate for quality of pulse.

Assist patient in performing assistive ROM exercises.

Encourage ambulation when possible.

Discourage wearing of constrictive clothes.

Administer oxygen as ordered.

SELECTED INTERVENTION Monitor the vital signs and note for any changes. Assess for skin coolness and color. Position on semi-fowler’s position. Encourage deep breathing exercises. Encourage adequate rest periods between activities. Measure capillary refill and palpate for quality of pulse. Assist patient in performing assistive ROM exercises. Encourage ambulation when possible. Discourage wearing of constrictive clothes. Administer oxygen as ordered.

IMPLEMENTED INTERVENTIONS Monitored the vital signs and note for any changes.

Assessed skin for coolness and color.

Positioned the patient on semi-fowler’s position.

Encouraged deep breathing exercises.

Encouraged adequate rest periods between activities.

Measured capillary refill and palpate for quality of pulse.

Assisted patient in performing assistive ROM exercises.

Encouraged ambulation when possible.

Discouraged wearing of constrictive clothes.

Administered oxygen as ordered.

IMPLEMENTED INTERVENTIONS Monitored the vital signs and note for any changes. Assessed skin for coolness and color. Positioned the patient on semi-fowler’s position. Encouraged deep breathing exercises. Encouraged adequate rest periods between activities. Measured capillary refill and palpate for quality of pulse. Assisted patient in performing assistive ROM exercises. Encouraged ambulation when possible. Discouraged wearing of constrictive clothes. Administered oxygen as ordered.

EVALUATION Goal Met After 2 hours of nursing intervention the patient was able to improved tissue perfusion Normalized capillary refill (1-3 seconds). Normalized the color of the skin.

EVALUATION Goal Met After 2 hours of nursing intervention the patient was able to improved tissue perfusion Normalized capillary refill (1-3 seconds). Normalized the color of the skin.

Psychological Nursing Care

Plan

ASSESSMENT Subjective:“Gusto ko na umuwi para makita ko na yung mga apo ko” as verbalized by the patient. Objective: Disinterest Boredom noted restlessness

NURSING DIAGNOSIS Deficient diversional activity related to prolonged hospitalization as manifested by boredom.

NURSING DIAGNOSIS Deficient diversional activity related to prolonged hospitalization as manifested by boredom.

SCIENTIC EXPLANATION Dilated myocardiopathy - is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.

SCIENTIC EXPLANATION Dilated cardiomyopathy - is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.


PLANNING Short term goal After 8 hours of nursing intervention the patient will be able to decrease boredom Expected outcome: Engage in satisfying activities within personal limitation.

PLANNING Short term goal After 8 hours of nursing intervention the patient will be able to decrease boredom Expected outcome: Engage in satisfying activities within personal limitation.


Assess client’s physical, emotional and environmental status.

Determine the client’s actual ability to participate / interest in available activities.

Acknowledge reality of situation and feelings of the client.

Acknowledge reality of situation and feelings of client to establish therapeutic relationship.

Encourage mixed desired activities/stimuli (e.g., music if available.)


Assess client’s physical, emotional and environmental status.

Determine the client’s actual ability to participate / interest in available activities.

Acknowledge reality of situation and feelings of the client. Acknowledge reality of situation and feelings of client to

establish therapeutic relationship. Encourage mixed desired activities/stimuli (e.g., music if

available.)


Assessed client’s physical, emotional and environmental status. Determined the client’s actual ability to participate / interest in available activities. Acknowledged reality of situation and feelings of the client.

Acknowledged reality of situation and feelings of client to establish therapeutic relationship.

Encouraged mixed desired activities/stimuli (e.g., music if available.)


Assessed client’s physical, emotional and environmental status.

Determined the client’s actual ability to participate / interest in available activities.

Acknowledged reality of situation and feelings of the client.

Acknowledged reality of situation and feelings of client to establish therapeutic relationship.

Encouraged mixed desired activities/stimuli (e.g., music if available.)

EVALUATION Goal Met After 8 hours of nursing intervention the patient will be improve Expected outcome: Engaged satisfying activities within personal limitation.

EVALUATION Goal Met After 8 hours of nursing intervention the patient will be improve Expected outcome: Engaged satisfying activities within personal limitation.

Potential Nursing Care

Plan

ASSESSMENT Objective: Restlessness Lethargy Crackles at left lung as auscultated

NURSING DIAGNOSIS Risk for fluid volume excess related to compromised regulatory mechanism secondary to left heart failure.

NURSING DIAGNOSIS Risk for fluid volume excess related to compromised regulatory mechanism secondary to left heart failure.


SCIENTIFIC EXPLANATION Dilated cardiomyopathy - is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.


PLANNING Short Term Goal: After 8 hours of nursing interventions the patient will be able stabilize fluid volume as evidence by balance or normal intake and output. Expected outcome: Demonstrate behaviors to monitor fluid status and reduce recurrence of fluid excess. Maintain balance or normal intake and output. Long Term Goal: After 4 weeks, patient will be able to maintain balance or normal fluid volume.

PLANNING Short Term Goal:After 8 hours of nursing interventions the patient will be able stabilize fluid volume as evidence by balance or normal intake and output. Expected outcome: Demonstrate behaviors to monitor fluid status and reduce

recurrence of fluid excess. Maintain balance or normal intake and output. Long Term Goal:After 4 weeks, patient will be able to maintain balance or normal fluid volume.


Assess for presence of edema.

Note amount/rate of fluid intake from all sources. Auscultate breath sounds. Note patterns .and amount of urination Promote ambulation as possible. Discuss importance of fluid restrictions. Stress need for mobility and/or frequent position changes. Administer diuretic medication as prescribed by the physician.


Assess for presence of edema. Note amount/rate of fluid intake from all sources. Auscultate breath sounds. Note patterns .and amount of urination Promote ambulation as possible. Discuss importance of fluid restrictions. Stress need for mobility and/or frequent position changes. Administer diuretic medication as prescribed by the

physician.


Assessed for presence of edema.

Noted amount/rate of fluid intake from all sources.

Auscultated breath sounds.

Noted patterns and amount of urination.

Promoted ambulation as possible.

Discussed importance of fluid restrictions.

Stressed need for mobility and/or frequent position changes. Administered diuretic medication as prescribed by the physician.


Assessed for presence of edema. Noted amount/rate of fluid intake from all sources. Auscultated breath sounds. Noted patterns and amount of urination. Promoted ambulation as possible. Discussed importance of fluid restrictions. Stressed need for mobility and/or frequent position

changes. Administered diuretic medication as prescribed by the

physician.

EVALUATION Short Term Goal: Goal Met After 8 hours of nursing intervention the patient was stabilized fluid volume as evidenced by normal or balance intake and output. Demonstrated behaviors to monitor fluid status and reduce recurrence of fluid excess. Maintained balance or normal intake and output.

EVALUATION Short Term Goal: Goal MetAfter 8 hours of nursing intervention the patient was stabilized fluid volume as evidenced by normal or balance intake and output. Demonstrated behaviors to monitor fluid status and

reduce recurrence of fluid excess. Maintained balance or normal intake and output.

ASSESSMENT Objective: Limited ROM Body weakness

NURSING DIAGNOSIS

Risk for injury related to inabililty to maintain balance

NURSING DIAGNOSIS Risk for injury related to inabililty to maintain balance

SCIENTIFIC EXPLANATION

Dilated myocardiopathy - is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.

SCIENTIFIC EXPLANATION Dilated cardiomyopathy - is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems. Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.


PLANNING

Short Term Goal: After 8 hours of nursing intervention the patient will be able to maintain safety and free from injury Expected Outcomes: Patient will identify factors or hazards that increase potential for injury. Patient will identify and apply safety measures to prevent injury.

Patient will be able to perform activities of daily living within limitations.

Patient or significant others will demonstrate ways to promote safety.

Long Term Goal: After 4 weeks, the patient will able to maintain safety and will report reduced risk of injury incidence.

PLANNING Short Term Goal:After 8 hours of nursing intervention the patient will be able to maintain safety and free from injury Expected Outcomes: Patient will identify factors or hazards that increase potential for

injury. Patient will identify and apply safety measures to prevent injury. Patient will be able to perform activities of daily living within

limitations. Patient or significant others will demonstrate ways to promote

safety.

Long Term Goal:After 4 weeks, the patient will able to maintain safety and will report reduced risk of injury incidence.

SELECTED INTERVENTIONS

Assess knowledge of safety needs or injury prevention and motivation.

Observe for factors and/or remove hazards that may cause or contribute to injury.

Orient patient to the environment and assess patient’s ability to use call bell, side rails and bed positioning controls. Keep bed at lowest level.

Advise patient to wear eye glasses.

Assist patient in performing activities of daily livings.

Encourage use of assistive devices.

Encourage significant others to supervise patient to perform range of motion exercises.

Monitor position.

Place call bell at the client’s reach if available.

Raise side rails and pad them according to agency protocol.

Use draw sheet as gait belt when assisting in ambulating or transferring.

SELECTED INTERVENTIONS

Assess knowledge of safety needs or injury prevention and motivation. Observe for factors and/or remove hazards that may cause or contribute

to injury. Orient patient to the environment and assess patient’s ability to use call

bell, side rails and bed positioning controls. Keep bed at lowest level. Advise patient to wear eye glasses. Assist patient in performing activities of daily livings. Encourage use of assistive devices. Encourage significant others to supervise patient to perform range of

motion exercises. Monitor position. Place call bell at the client’s reach if available. Raise side rails and pad them according to agency protocol. Use draw sheet as gait belt when assisting in ambulating or transferring.


Assessed knowledge of safety needs or injury prevention and motivation. Observed for factors and/or remove hazards that may cause or contribute to injury. Oriented patient to the environment and assess patient’s ability to use call bell, side rails and bed positioning controls. Keep bed at lowest level. Advised patient to wear eye glasses. Assisted patient in performing activities of daily livings. Encouraged use of assistive devices. Encouraged significant others to supervised patient to perform range of motion exercises. Monitored position.

Placed call bell at the client’s reach.

Raised side rails and padded them according to agency protocol.

Used draw sheet as gait belt when assisting in ambulating or transferring.


Assessed knowledge of safety needs or injury prevention and motivation. Observed for factors and/or remove hazards that may cause or contribute

to injury. Oriented patient to the environment and assess patient’s ability to use

call bell, side rails and bed positioning controls. Keep bed at lowest level. Advised patient to wear eye glasses. Assisted patient in performing activities of daily livings. Encouraged use of assistive devices. Encouraged significant others to supervised patient to perform range of

motion exercises. Monitored position. Placed call bell at the client’s reach. Raised side rails and padded them according to agency protocol. Used draw sheet as gait belt when assisting in ambulating or

transferring.

EVALUATION

Short Term Goal: Goal Met After 8 hours of nursing intervention the patient was able to maintain safety with participation of family members and free from injury. No report of any falls.

EVALUATION Short Term Goal: Goal Met After 8 hours of nursing intervention the patient was able to maintain safety with participation of family members and free from injury. No report of any falls.

Drug Study:

DRUG NAME DOSAGE ACTIONBrand Name:Kalium DuruleGeneric Name:Potassium ChlorideClassification: mineral and electrolyte replacements/supplements

1 tab/BID Maintain acid-base balance, isotonicity, and electrophysiological balance of the cell

Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism.

DRUG NAME DOSAGE ACTIONBrand Name:Kalium DuruleGeneric Name:Potassium ChlorideClassification: mineral and electrolyte replacements/supplements

1 tab/BID

Maintain acid-base balance, isotonicity, and electrophysiological balance of the cell

Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism.

INDICATION CONTRAINDICATIONPO/IV: Treatment/prevention of potassium

depletion IV : Arrhythmias due to digoxin toxicity

Hyperkalemia Severe renal impairment Untreated Addison’s disease Severe tissue trauma Hyperkalemic familial periodic paralysis

INDICATION CONTRAINDICATIONPO/IV: Treatment/

prevention of potassium depletion

IV : Arrhythmias due to

digoxin toxicity

Hyperkalemia Severe renal impairment Untreated Addison’s disease Severe tissue trauma Hyperkalemic familial periodic

paralysis

ADVERSE REACTIONS NURSING RESPONSIBILITIESCNS: confusion, restlessness, weakness. CV: ARRHYTHMIAS, ECG changes. GI: abdominal pain, diarrhea, flatulence, nausea, vomiting; tablets, capsules only— GI ulceration, stenotic lesions. Local: irritation at IV site. Neuro: paralysis, paresthesia.

Assess for signs and symptoms of hypokalemia and hyperkalemia

Monitor pulse, blood pressure, and ECG periodically during IV therapy.

Administer with or after meals to decrease GI irritation.

ADVERSE REACTIONS NURSING RESPONSIBILITIESCNS: confusion, restlessness, weakness. CV: ARRHYTHMIAS, ECG changes. GI: abdominal pain, diarrhea, flatulence, nausea, vomiting; tablets, capsules only— GI ulceration, stenotic lesions. Local: irritation at IV site. Neuro: paralysis, paresthesia.

Assess for signs and symptoms of hypokalemia and hyperkalemia

Monitor pulse, blood pressure, and ECG periodically during IV therapy.

Administer with or after meals to decrease GI irritation.

DRUG NAME DOSAGE ACTION

Brand Name:Aldactone Generic Name:Spironolactone Classification:Potassium sparing diuretics

25 mg tab/OD Cause loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions.

DRUG NAME DOSAGE ACTIONBrand Name:Aldactone Generic Name:Spironolactone Classification:Potassium sparing diuretics

25 mg tab/OD

Cause loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions.

INDICATION CONTRAINDICATION

Counteract potassium loss caused by other diuretics Used with other agents (thiazides) to treat edema or

hypertension Hyperaldosteronism (spironolactone only).

Hypersensitivity to drug Hyperkalemia.

INDICATION CONTRAINDICATION Counteract potassium

loss caused by other diuretics

Used with other agents (thiazides) to treat edema or hypertension

Hyperaldosteronism (spironolactone only).

Hypersensitivity to drug Hyperkalemia.

ADVERSE REACTIONS NURSING RESPONSIBILITIES

CNS: dizziness; spironolactone only clumsiness, headache. CV: arrhythmias. GI: amiloride— constipation, GI irritation (increased with spironolactone). GU: impotence, triamterene— bluish urine, nephrolithiasis. Derm: triamterene— photosensitivity. Endo: spironolactone— gynecomastia. F and E: hyperkalemia, hyponatremia. Hemat: spironolactone and triamterene— dyscrasias. MS: muscle cramps. Misc: allergic reactions.

Monitor intake and output ratios and daily weight during therapy. If medication is given as an adjunct to antihypertensive therapy,

monitor blood pressure before administering. Monitor response of signs and symptoms of hypokalemia Administer in AM to avoid interrupting sleep pattern. Administer with food or milk to minimize gastric irritation and to

increase bioavailability

ADVERSE REACTIONS NURSING RESPONSIBILITIESCNS: dizziness; spironolactone only clumsiness, headache. CV: arrhythmias. GI: amiloride— constipation, GI irritation (increased with spironolactone). GU: impotence, triamterene— bluish urine, nephrolithiasis. Derm: triamterene— photosensitivity. Endo: spironolactone— gynecomastia. F and E: hyperkalemia, hyponatremia. Hemat: spironolactone and triamterene— dyscrasias. MS: muscle cramps. Misc: allergic reactions.

Monitor intake and output ratios and daily weight during therapy.

If medication is given as an adjunct to antihypertensive therapy, monitor blood pressure before administering.

Monitor response of signs and symptoms of hypokalemia

Administer in AM to avoid interrupting sleep pattern.

Administer with food or milk to minimize gastric irritation and to increase bioavailability


Brand Name:Duphalac Generic Name:Lactulose Classification:Laxative

2 tabs/ ODHS Increases water content and softens the stool Lowers the pH of the colon, which inhibits the

diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels

Relief of constipation

DRUG NAME DOSAGE ACTIONBrand Name:Duphalac Generic Name:Lactulose Classification:Laxative

2 tabs/ ODHS

Increases water content and softens the stool

Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels

Relief of constipation


Treatment of chronic constipation in adults and geriatric patients

Patients on low-galactose diets.

INDICATION CONTRAINDICATION Treatment of chronic

constipation in adults and geriatric patients

Patients on low-galactose diets.


GI: belching, cramps, distention, flatulence, diarrhea. Endo: hyperglycemia (diabetic patients).

Assess patient for abdominal distention, presence of bowel sounds, and normal pattern of bowel function.

Assess color, consistency, and amount of stool produced With fruit juice, water, milk, or carbonated citrus beverage to improve flavor.

Administer with a full glass (240 ml) of water or juice. May be administered on an empty stomach for more rapid results

ADVERSE REACTIONS NURSING RESPONSIBILITIESGI: belching, cramps, distention, flatulence, diarrhea. Endo: hyperglycemia (diabetic patients).

Assess patient for abdominal distention, presence of bowel sounds, and normal pattern of bowel function.

Assess color, consistency, and amount of stool produced

With fruit juice, water, milk, or carbonated citrus beverage to improve flavor. Administer with a full glass (240 ml) of water or juice. May be administered on an empty stomach for more rapid results


Brand Name:Renitec Generic Name:Enalapril Classification:Anti-hypertensiveACE inhibitors

5mg ½ tab

ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II.

Lowering of blood pressure in hypertensive patients

Decreased afterload in patients with CHF

Decreased development of overt heart failure

Decreased progression of diabetic nephropathy

DRUG NAME DOSAGE ACTIONBrand Name:Renitec Generic Name:Enalapril Classification:Anti-hypertensiveACE inhibitors

5mg ½ tab ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II.

Lowering of blood pressure in hypertensive patients

Decreased afterload in patients with CHF

Decreased development of overt heart failure

Decreased progression of diabetic nephropathy

INDICATION CONTRAINDICATION Alone

or with other agents in the management of hypertension

Slowed progression of left ventricular dysfunction into overt heart failure (selected agents)

Hypersensitivity Cross-sensitivity

among ACE inhibitors may occur

Angioedema (hereditary or idiopathic).

INDICATION CONTRAINDICATION Alone or with

other agents in the management of hypertension

Slowed progression of left ventricular dysfunction into overt heart failure (selected agents)

Hypersensitivity Cross-sensitivity among ACE

inhibitors may occur Angioedema (hereditary or

idiopathic).

ADVERSE REACTION

NURSING

RESPONSIBI

LITIES

CNS: dizziness, fatigue, headache, insomnia, weakness. Resp: cough , eosinophilic pneumonitis. CV: hypotension , angina pectoris, tachycardia. GI: taste disturbances , anorexia, diarrhea, nausea. GU: proteinuria , impotence, renal failure. Derm: rashes. F and E: hyperkalemia. Hemat: Agranulocytosis neutropenia (captopril only) . Misc:angioedema, fever.

Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.

Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).

ADVERSE REACTION NURSING RESPONSIBILITIES

CNS: dizziness, fatigue, headache, insomnia, weakness. Resp: cough , eosinophilic pneumonitis. CV: hypotension , angina pectoris, tachycardia. GI: taste disturbances , anorexia, diarrhea, nausea. GU: proteinuria , impotence, renal failure. Derm: rashes. F and E: hyperkalemia. Hemat: Agranulocytosis neutropenia (captopril only) . Misc:angioedema, fever.

Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.

Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).

DRUG NAME DOSAGE ACTIONBrand Name:Lanoxin Generic Name:Digoxin Classification:antiarrhythmics, inotropics

0.25mg ½ tab OD

Increases the force of myocardial contraction

Prolongs refractory period of the AV node

Decreases conduction through the SA and AV nodes.

DRUG NAME DOSAGE ACTIONBrand Name:Lanoxin Generic Name:Digoxin Classification:antiarrhythmics, inotropics

0.25mg ½ tab OD

Increases the force of myocardial contraction

Prolongs refractory period of the AV node

Decreases conduction through the SA and AV nodes.

INDICATION CONTRAINDICATION Treatment of CHF Tachyarrhythmias

Hypersensitivity Uncontrolled ventricular arrhythmias AV block Idiopathic hypertrophic subaortic stenosis Constrictive pericarditis

INDICATION CONTRAINDICATION Treatment of CHF Tachyarrhythmias

Hypersensitivity Uncontrolled ventricular

arrhythmias AV block Idiopathic hypertrophic

subaortic stenosis Constrictive pericarditis

ADVERSE REACTION NURSING RESPONSIBILITIESCNS: fatigue , headache, weakness. EENT: blurred vision, yellow vision. CV: ARRHYTHMIAS , bradycardia , ECG changes. GI: anorexia , nausea , vomiting , diarrhea. Endo: gynecomastia. Hemat: thrombocytopenia

Monitor apical pulse for 1 full min before administering. Withhold dose and notify physician if pulse rate is <60 bpm

Monitor blood pressure periodically in patients receiving IV digoxin.

Oral preparations can be administered without regard to meals

ADVERSE REACTION NURSING RESPONSIBILITIESCNS: fatigue , headache, weakness. EENT: blurred vision, yellow vision. CV: ARRHYTHMIAS , bradycardia , ECG changes. GI: anorexia , nausea , vomiting , diarrhea. Endo: gynecomastia. Hemat: thrombocytopenia

Monitor apical pulse for 1 full min before administering. Withhold dose and notify physician if pulse rate is <60 bpm

Monitor blood pressure periodically in patients receiving IV digoxin.

Oral preparations can be administered without regard to meals


Brand Name:Imdur Generic Name;Isosorbide5-mononitrate Classification:Anti-anginal

60mg ½ tab OD Produce vasodilation (venous greater than arterial)

Decrease left ventricular end-diastolic pressure and left ventricular end-diastolic volume (preload). Net effect is reduced myocardial oxygen consumption

Increase coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions.

DRUG NAME DOSAGE ACTIONBrand Name:Imdur Generic Name;Isosorbide5-mononitrate Classification:Anti-anginal

60mg ½ tab OD

Produce vasodilation (venous greater than arterial)

Decrease left ventricular end-diastolic pressure and left ventricular end-diastolic volume (preload). Net effect is reduced myocardial oxygen consumption

Increase coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions.


Acute treatment of anginal attacks (SL only) Prophylactic management of angina pectoris (dinitrate

and mononitrate) Treatment of chronic CHF (dinitrate).

Hypersensitivity Severe anemia. Concurrent use of sildenafil

INDICATION CONTRAINDICATION Acute treatment of

anginal attacks (SL only) Prophylactic

management of angina pectoris (dinitrate and mononitrate)

Treatment of chronic CHF (dinitrate).

Hypersensitivity Severe anemia. Concurrent use of sildenafil


CNS: dizziness , headache , apprehension, weakness. CV: hypotension , tachycardia , paradoxic bradycardia, syncope. GI: abdominal pain, nausea, vomiting. Misc: cross-tolerance, flushing, tolerance.

Assess location, duration, intensity, and precipitating factors of anginal pain.

Administer 1 hr before or 2 hr after meals with a full glass of water for faster absorption.

ADVERSE REACTIONS NURSING RESPONSIBILITIESCNS: dizziness , headache , apprehension, weakness. CV: hypotension , tachycardia , paradoxic bradycardia, syncope. GI: abdominal pain, nausea, vomiting. Misc: cross-tolerance, flushing, tolerance.

Assess location, duration, intensity, and precipitating factors of anginal pain.

Administer 1 hr before or 2 hr after meals with a full glass of water for faster absorption.


Brand Name:Januvia Generic Name:Sitagliptin phosphate Classification:Anti diabetic

100mg tab OD

Slows the inactivation of the incretin hormones, increasing these hormone levels and prolonging their activity. The incretin hormones stimulate insulin release in response to a meal and help to regulate glucose homeostasis throughout the day. This increases and prolongs insulin release and reduce hepatic glucose production to help achieve glycemic control.

DRUG NAME DOSAGE ACTIONBrand Name:Januvia Generic Name:Sitagliptin phosphate Classification:Anti diabetic

100mg tab OD

Slows the inactivation of the incretin hormones, increasing these hormone levels and prolonging their activity. The incretin hormones stimulate insulin release in response to a meal and help to regulate glucose homeostasis throughout the day. This increases and prolongs insulin release and reduce hepatic glucose production to help achieve glycemic control.

INDICATION CONTRAINDICATIONAdjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus, as monotheraphy or with other oral antidiabetic.

contraindicated with history of serious hypersensitivity reactions to sitagliptin

INDICATION CONTRAINDICATIONAdjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus, as monotheraphy or with other oral antidiabetic.

contraindicated with history of serious hypersensitivity reactions to sitagliptin

ADVERSE

REACTIONS

NURSING

RESPONSIBILITIESCNS; HeadacheRespi: nasopharyngitis, URlsOther: hypoglycemia

Monitor blood glucose levels and HbA1C before and periodically during therapy

Ensure that patient continues exercise and diet program for management of type – 2 diabetes mellitus

Monitor baseline renal function tests before and periodically during therapy

ensure that patient will continues with appropriate use of other drugs to manage type 2 diabetes mellitus if indicated

arrange for thorough diabetic teaching program to include diet, exercise, S&S of hypoglycemia and hyperglycemia, safety measures to avoid infections, injuries.

ADVERSE REACTIONS

NURSING RESPONSIBILITIES

CNS; HeadacheRespi: nasopharyngitis, URlsOther: hypoglycemia

Monitor blood glucose levels and HbA1C before and periodically during therapy

Ensure that patient continues exercise and diet program for management of type – 2 diabetes mellitus

Monitor baseline renal function tests before and periodically during therapy

ensure that patient will continues with appropriate use of other drugs to manage type 2 diabetes mellitus if indicated

arrange for thorough diabetic teaching program to include diet, exercise, S&S of hypoglycemia and hyperglycemia, safety measures to avoid infections, injuries.

DRUG NAME DOSAGE ACTIONBrand Name:Glucophage XR Generic Name:Metformin Classification:Anti-diabeticBiguanides

1g q12

Decreases hepatic glucose production

Decreases intestinal glucose absorption

Increases sensitivity to insulin.

Maintenance of blood glucose

DRUG NAME DOSAGE ACTIONBrand Name:Glucophage XR Generic Name:Metformin Classification:Anti-diabeticBiguanides

1g q12

Decreases hepatic glucose production

Decreases intestinal glucose absorption

Increases sensitivity to insulin.

Maintenance of blood glucose

INDICATION CONTRAINDICATIONS Manage

ment of type 2 diabetes mellitus; may be used with diet, insulin, or sulfonylurea oral hypoglycemics.

Hypersensitivity Metabolic acidosis Dehydration, sepsis,

hypoxemia, hepatic impairment, excessive alcohol use (acute or chronic)

Renal dysfunction (serum creatinine >1.5 mg/dl in men or >1.4 mg/dl in women)

Radiographic studies requiring IV iodinated contrast media (withhold metformin)

INDICATION CONTRAINDICATIONS Management of

type 2 diabetes mellitus; may be used with diet, insulin, or sulfonylurea oral hypoglycemics.

Hypersensitivity Metabolic acidosis Dehydration, sepsis, hypoxemia,

hepatic impairment, excessive alcohol use (acute or chronic)

Renal dysfunction (serum creatinine >1.5 mg/dl in men or >1.4 mg/dl in women)

Radiographic studies requiring IV iodinated contrast media (withhold metformin)

ADVERSE REACTIONS

NURSING REESPONSIBILITIES

GI: abdominal bloating , diarrhea , nausea , vomiting , unpleasant metallic taste. Endo: hypoglycemia. F and E:lactic acidosis. Misc: decreased vitamin B 1 2 levels.

Observe patient for signs and symptoms of hypoglycemic reactions

ADVERSE REACTIONS NURSING REESPONSIBILITIESGI: abdominal bloating , diarrhea , nausea , vomiting , unpleasant metallic taste. Endo: hypoglycemia. F and E:lactic acidosis. Misc: decreased vitamin B 1 2 levels.


DRUG NAME DOSAGE ACTIONBrand Name:Arya Generic Name:Glimeperide Classifications:antidiabetic

2mg 1tab before breakfast

Lower blood glucose by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites

May also decrease hepatic glucose production

DRUG NAME DOSAGE ACTIONBrand Name:Arya Generic Name:Glimeperide Classifications:antidiabetic

2mg 1tab before breakfast

Lower blood glucose by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites

May also decrease hepatic glucose production

INDICATION CONTRAINDICATION Control

of blood glucose in adult-onset non–insulin-dependent diabetes mellitus (type 2) when diet therapy fails. Require some pancreatic function.

Hypersensitivity Cross-sensitivity

with sulfonamides (including thiazide diuretics) may occur

Insulin-dependent patients with diabetes

Diabetic coma or ketoacidosis

Severe renal, hepatic, thyroid, or other endocrine disease

Uncontrolled infection, serious burns, or trauma.

INDICATION CONTRAINDICATION Control of blood

glucose in adult-onset non–insulin-dependent diabetes mellitus (type 2) when diet therapy fails. Require some pancreatic function.

Hypersensitivity Cross-sensitivity with

sulfonamides (including thiazide diuretics) may occur

Insulin-dependent patients with diabetes

Diabetic coma or ketoacidosis Severe renal, hepatic, thyroid, or

other endocrine disease Uncontrolled infection, serious

burns, or trauma.

ADVERSE REACTIONNURSING

RESPONSIBILITIES

CNS: dizziness, drowsiness, headache, weakness. GI: constipation, cramps, diarrhea, drug-induced hepatitis, heartburn, increased appetite, nausea, vomiting. Derm: photosensitivity , rashes. Endo: hypoglycemia . F and E: hyponatremia. Hemat:aplastic anemia, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia.


Assess patient for allergy to sulfonamides

May be administered once in the morning or divided into 2 doses. Administer most sulfonylureas with meals to ensure best diabetic control and to minimize gastric irritation. Do not administer after last meal of the day.

ADVERSE REACTION NURSING RESPONSIBILITIESCNS: dizziness, drowsiness, headache, weakness. GI: constipation, cramps, diarrhea, drug-induced hepatitis, heartburn, increased appetite, nausea, vomiting. Derm: photosensitivity , rashes. Endo: hypoglycemia . F and E: hyponatremia. Hemat:aplastic anemia, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia.


Assess patient for allergy to sulfonamides

May be administered once in the morning or divided into 2 doses. Administer most sulfonylureas with meals to ensure best diabetic control and to minimize gastric irritation. Do not administer after last meal of the day.

DRUG NAME DOSAGE ACTIONBrand Name:AM- Europharma furosemide Generic Name:Furosemide IV Classification:antihypertensive

40 mg IV q12 Inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

DRUG NAME DOSAGE ACTIONBrand Name:AM- Europharma furosemide Generic Name:Furosemide IV Classification:antihypertensive

40 mg IV q12 Inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

INDICATIONCONTRAINDICATI

ONS Acute

pulmonary edema

hypertension

hypersensitivity to drug

anuria

INDICATION CONTRAINDICATIONS Acute pulmonary

edema hypertension

hypersensitivity to drug

anuria

ADVERSE

REACTIONS

NURSING

RESPONSIBILITIE

SHeadache, dizziness, weakness, restlessness, orthostatic hypotension, nausea and vomiting, anorexia, polyuria, anemia, muscle spasms

Monitor weight, blood pressure, and Pulse rate routinely with long term use

Monitor I&O, electrolytes, BUN, and carbon dioxide levels

Watch out for signs of hypokalemia

Monitor glucose with diabetic patients

Advise to take drugs with food to prevent GI upset

Inform patient for possible need of potassium and magnesium supplements

ADVERSE REACTIONS NURSING RESPONSIBILITIESHeadache, dizziness, weakness, restlessness, orthostatic hypotension, nausea and vomiting, anorexia, polyuria, anemia, muscle spasms

Monitor weight, blood pressure, and Pulse rate routinely with long term use

Monitor I&O, electrolytes, BUN, and carbon dioxide levels

Watch out for signs of hypokalemia Monitor glucose with diabetic

patients Advise to take drugs with food to

prevent GI upset Inform patient for possible need of

potassium and magnesium supplements

DRUG NAME DOSAGE ACTION INDICATIONBrand Name:Coralan Generic name:Ivabradine HCL Classification:Anti anginal

5mg tab OD

A pure heart rate-lowering agent, acting by selective and specific inhibition of the cardiac pacemaker If current that controls the spontaneous diastolic depolarisation in the sinus node and regulates heart rate.

For treatment of chronic stable angina pectoris in coronary artery disease

patients with normal sinus rhythms

DRUG NAME DOSAGE ACTION INDICATIONBrand Name:Coralan Generic name:Ivabradine HCL Classification:Anti anginal

5mg tab OD

A pure heart rate-lowering agent, acting by selective and specific inhibition of the cardiac pacemaker If current that controls the spontaneous diastolic depolarisation in the sinus node and regulates heart rate.

For treatment of chronic

stable angina pectoris in coronary

artery disease

patients with normal sinus

rhythms

CONTRAINDICATION ADVERSE REACTIONS NURSING RESPONSIBILITIES Sick sinus syndrome SA block severe heart failure Unstable angina

Luminous phenomena Blurred vision Bradycardia 1st degree AV block Ventricular extrasystoles Headache Dizziness

Should be taken with food (Avoid excessive consumption of grapefruit juice.).

CONTRAINDICATIONADVERSE

REACTIONSNURSING

RESPONSIBILITIES Sick sinus

syndrome SA block

severe heart failure

Unstable angina

Luminous phenomena

Blurred vision Bradycardia 1st degree AV

block Ventricular

extrasystoles Headache Dizziness

Should be taken with food (Avoid excessive consumption of grapefruit juice.).

DRUG NAME DOSAGE ACTION INDICATIONBrand name:Vastarel Generic name:Trimetazidine Classification:Anti-anginal

35mg BID Anti ischemic metabolic agent, which improves myocardial glucose utilization through stopping of fatty acid metabolism

Long term treatment of

coronary insufficiency,

angina pectoris

DRUG NAME DOSAGE ACTION INDICATIONBrand name:Vastarel Generic name:Trimetazidine Classification:Anti-anginal

35mg BID Anti ischemic metabolic agent, which improves myocardial glucose utilization through stopping of fatty acid metabolism

Long term treatment of

coronary insufficiency,

angina pectoris


REACTIONSNURSING

RESPONSIBILITIESHypersensitivity to

drug

Epigastric pain Dyspepsia Nausea and

vomiting Headache Dizziness Pruritus Orthostatic

hypotension

Used continuously in patients with heart

failure or hypertension and in

elderly patients.


REACTIONSNURSING

RESPONSIBILITIESHypersensitivity to

drug

Epigastric pain Dyspepsia Nausea and

vomiting Headache Dizziness Pruritus Orthostatic

hypotension

Used continuously in patients with heart

failure or hypertension and in

elderly patients.

Discharge Planning

Medicines:* Take medication(s) exactly as prescribed* Teach the patient purpose, dose and side effect of each ….medication.* Encourage patient to establish cues that will remind him to ….take his medication.* ACE inhibitors (angiotensin-converting enzyme inhibitors)—….help open the arteries and lower blood pressure, improving ….blood flow.

* Diuretics—or “water pills" to help keep fluid from building up ….in your body and lungs, which helps you breathe easier.* Beta blockers—help to improve blood pressure and may help ….prevent some heart rhythm problems.* Digoxin─Also called “digitalis,” digoxin helps the heart pump ….better.* Lipid-lowering drugs—to help lower cholesterol in patients to ….decrease the likelihood of new buildup.* Anti-hypertensive medications─these drugs lower blood ….pressure and help prevent heart failure or prevent it from ….worsening.

Exercise/ Activity:

• Moderate exercise (an accumulation of 30 to 60 min.) of walking (ideally brisk walking)

• jogging or other dynamic exercise 4 to 7 days each week in addition to routine activities of daily living Medically supervised exercise programs for high-risk patients.

• Maintain a consistent daily routine• Get adequate rest and sleep

• Elevating legs at rest

Treatment:

Daily weight monitoringAdvice to have a smoking cessationInstructions on how to care his self at home

Health Teaching:

Weight: Maintain goal of a body mass index (BM) of 18.5 to 24.8 kg/ and a waist circumference of <88 cm for women Weigh yourself daily (with assistance) to detect increased fluid retentionKeep weight at optimal level, normalize body weightWeigh weeklyKeep a weight recordStay in Smoke-free environment.

Explain the meaning of high blood pressure, risk factors, and their influences on the cardiovascular, cerebral and renal systems.Avoid extremes in temperature.Avoid significant physical labor and emotional stress. Avoid fatigue by planning rest periodsFamiliarize yourself regularly with your blood pressure and heart rate. Instruct the patient the signs and symptoms of CHF and immediately report any to his physician: edema, increased shortness of breath, distended neck veins, weight gain, persistent cough, and increased urination at night.

Outpatient (follow-up)Visit the physician on a regular basisInstruct the patient to tell to his caregiver about signs and symptoms.Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

DietEncourage a heart-healthy dietDietary restriction of sodium (salt) Limit caffeine and alcohol intakeLess added fat, fewer fatty foods, and low cholesterol items are recommended. Polyunsaturated (vegetable) fats should be used in place of saturated fats.Restrict fluids if ordered by your physician.

Healthy balanced diet: High in fresh fruits, vegetables, low-fat dairy products, dietary and soluble fiber, whole grains and protein from plant sources and low in saturated fat, cholesterol and sodium.Alcohol consumption: two or fewer standard drinks per day; and fewer standard drinks per day, and fewer than 14 drinks per week for men; and fewer than 9 drinks per day; and fewer than 9 drinks per week for women.

Spiritual well being:

Encourage patient to read bible or continue to her spiritual beliefs every day and always seek for God’s help whenever problems occur.

Thank You So Much…

dilated cardiomyopathy case study

Documents

patient s symptoms

patient s father

patient s mother

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patient s younger child

nursing care plan appropriate

valsalva s maneuver

family history of illness