Pulmonary Oedema in Contemporary †Free Samples to Students

Question: Discuss about the Pulmonary Oedema in Contemporary. Answer: Introduction: In the given case study, information has been presented about a 72 year old patient named Giovanni who has been suffering from Chronic Heart Failure and presented to the Emergency department in the hospital with complaints of shortness of breath and a sensation of breathing. Management of chronic heart failure thus will be carried out (heartfoundation.org.au, 2017). His symptom of dyspnoea was not relived immediately. Further, it was seen that his breathlessness symptoms has been bothering him since quite long interfering with his activities of daily living. His swollen foot also posed problems for him in wearing shoes. Inquiring about his lifestyle revealed that he has been a smoker and is unable to maintain his diet and pursue proper exercise regime. Subsequent undertaking of diagnostic tests and assessments of vital parameters showed that he has acute manifestation of heart failure. Hence, the two nursing priorities at this hour should aim to address his distressed breathing and p roblems related to swollen foot effectively. Assessment of the patient carried out on admission to the emergency department revealed that he has been feeling out of breath and suffocated due to accelerated heart rate and respiratory rate. This feeling of puffiness and difficulty in performing the activities of daily living has been bothering him since the last few days as reported to the Registered Nurse by Giovanni himself. He admitted of being a chain smoker and assessment of his health record reveals that within 30 minutes of waking he resorts to smoking and the number of cigarettes smoked per day goes up to 20. Further he expressed his inability to curb this behavior and modifying his diet and exercise regime for a healthy lifestyle. He has already been diagnosed with chronic heart failure and has been under medications to tackle the condition as suggested by the physician. His chest X-ray examination is further suggestive of acute manifestation of chronic heart failure. Considering his age and in contrast to his height, he was found to be overweight and therefore is designated as being severely obese based on his calculated BMI (Sharma et al., 2015). Therefore proper planning in the form of nursing interventions is desirable to address the condition. The primary goal of such intervention will be to alleviate the symptoms of breathlessness and chest discomfort in the patient (Brake Jones, 2017). Proper lifestyle modification through curbing the rates of smoking and controlling the dietary and exercise pattern in the patient will ensure the success of the projected objectives of reliving the cardiorespiratory difficulties (Yancy et al., 2013). Empirical findings have suggested that smoking and unhealthy lifestyle in absence of adequate exercise and proper nutrition pose great threats to the onset as well as aggravation of the chronic heart failure conditions (Kotseva et al., 2016). Hence it is likely that the collective and individual interventions applied to the patients will pave the way for optimum and better outcomes in the patient without compromising on the health front. It is expected as part of the evaluation outcomes that the patient will express satisfaction on observance of the therapeutic interventions by means of less complaint of chest discomfort and improved mode of lifestyle through weight mitigation and abandoning the habit of smoking completely. Nursing Interventions The nursing intervention in connection to the lifestyle modification of the patient to treat his condition due to chronic heart failure must be addressed in a collaborative way with vital inputs from professionals across various related interdisciplinary domains (Lavie, Arena Franklin, 2016). Primarily the chest discomfort will be acted upon through proper medication as suggested by the physician. The preliminary recommendation for carrying out an effective healthy lifestyle will involve a healthy weight management through maintenance of a well balanced diet and doing regular exercise. A diet rich in vegetables, fruits and whole grains is considered good for cardiovascular functioning. Food low in carbohydrate and fat will be encouraged to take by the patient with adequate amount of protein. Foodstuffs containing higher amount of salts, solid fats, refined grains and added sugars must be strictly avoided. The cardiac rehabilitation team comprising of the nutritionist, exercise thera pist, physician, and nurse will all act in coalition to harbor positive outcomes for Giovanni. Expert guidance will be sought from the physical therapist to suggest suitable moderate intensity aerobic exercise pertinent to the patient to lend cardio-protective function (Ades et al., 2013). Further for abatement of the smoking habit in the patient transdermal nicotine patches will be used as smoking deterrent. It will act to provide low dosage of nicotine through acting by means of lessening the physical signs of withdrawal symptoms and aiding in quitting smoking (Ferguson et al., 2016). Salt consumption diet need to be strictly monitored and regulated further to optimize the outcomes. The registered nurse (RN) will keep a track of the patient progress and report to the attending doctor in a timely manner. Emphasis must be laid on being active and maintain a healthy diet to keep the symptoms at bay. Concomitant to the weight loss and dietary management improvement in the symptoms of breathlessness and others will follow in a cascade manner (Clark, Fonarow Horwich, 2014). Thus the lifestyle modification varied out with respect to effective cardiac rehabilitation procedure will ensure better results. The feeling of puffiness in the patient alongside associated symptoms of breathlessness and difficulty in doing ADLs due to physical exertion may be properly addressed by virtue of proper medicinal intervention by administering beta blocker drug such as atenolol as prescribed by the physician. Oral route of administration will be followed by giving 50 mg on a daily basis to the patient (davisplus.fadavis.com, 2017). The chest discomfort will be reduced by means of administering atenolol. The rapid heart rate will be reduced on taking this medicine. However care must be taken to observe for any adverse reaction or side effects. However it must be checked for food or lifestyle interactions. Consumption of large amount of orange juice must be prevented as it might decrease the effectiveness of atenolol. Interactions with drugs like that of lisinopril and furosemide that have been prescribed to the patient must be checked for any adverse reaction (Heusch et al., 2014). Thus reduction in the signs and symptoms of chronic heart failure will indirectly help in enhancing the QOL of the patient through improvement in hearty function. If symptoms including blurred vision, confusion, sweating, wheezing, anxiety, weight gain, nausea, diarrhea, trouble sleeping are noted in the patient then medication must be stopped and referral to the doctor must be made. The blood pressure, ECG and pulse must be monitored frequently in course of the dosage and adjustment period as well as periodically throughout the therapy. The intake and output ratios in addition to the weight also need to be checked routinely. Signs of toxicity and overdose must not be overlooked and prompt notification to the physician must be undertaken. Thus every effort must be made so that the patient complies with the prescribed medication allaying the possibility of any harm or side effects (DeJongh, Birkeland Brenner, 2015). Evaluation of the patient on admission to the hospital further brought to the forefront an issue relevant to the difficulty in wearing shoes due to swollen foot of the patient over the last couple of days. This report may be further corroborated with the revelation of pitting edema in both the limbs of the patient. The weakness of the heart in conjunction with the diminished blood flow accounts for fluid accumulation and retention in the lower region of the body in the limbs (Platz et al., 2015). Moreover the patient also complained that he faced issue while moving indoor at home and encountered much difficulty in motion. Results from the patient risk assessment further demonstrated that he has difficulty in normal functioning and is requiring assistance of a person in doing activities of daily living (ADL) such as that for dressing, bathing, eating, toileting, transfers and mobility. Moreover the factors that pose risks for fall in case of the patient were identified as his age over 65 years, weakness in the limbs, imbalance and gait problems. His restricted movements and inability to perform day to day tasks independently seemed to have rendered a psychological pressure in Giovanni as he has been reported to have mood swings encompassing feelings of moroseness, depression and hopelessness. Thus a referral to the psychological mentor and counselor is imperative to take care of his mental health status (Tully et al., 2015). Hence, both mental and physical health interventions will aid to improve his condition by resorting to appropriate measures. The short term goal in this context will be to improve the mobility of the patient by mitigating the symptoms of leg edema (Trayes et al., 2013). The patient must be able to walk independently and perform the ADL efficiently devoid of any support. Further his quality of living (QOL) is likely to be enhanced on following the measures in an appropriate manner and complying to the recommended medications or any other inte rventions effectively. The depressive mood symptoms are also expected to be mitigated upon proper therapeutic intervention. Nursing Interventions In case of chronic heart failure, pitting edema is a common complaint among the patients, and in this case this has lead to obstructing the ADL for the patient. Therefore efforts to reduce these symptoms so that he may get back to his normal living need to be reiterated. In an effort to manage the swelling of the foot compliance to proper medications is advised that need to be strictly supervised and given by the attending nursing professional as directed by the physician (davisplus.fadavis.com, 2017). In this context, the furosermide medicine as suggested by the physician to treat his existing heart failure condition may be applied. It will act by inhibiting the reabsorption of salts and cause excessive renal excretion of water through increased mobilization of excess fluid. Symptoms for any contraindications or adverse drug reactions must be closely observed and must be reported to the physician appropriately. The drug must be administered through the intravenous route in 40 mg dos age as prescribed by the physician in proper intervals. The fluid status of the patient must be assessed properly to direct the treatment modality (Ballester, et al., 2015). Blood pressure and pulse must be monitored both before and after administration. The monitoring of the renal and hepatic function also needs to be followed for evaluating the efficacy of the drug prescribed (Gaalema et al., 2017). Dose must not be missed under any circumstances to increase the efficiency of the action of the drug. Dehydration must be strictly avoided in course of the medication duration and the nurse must take measures to ensure that the patient is taking fluid in adequate quantity. The recommended dose of medication must be given carefully as overdose of furosemide may lead to irreversible hearing loss (Kelm et al., 2015). Thus furosemide may be applicable to ameliorate the symptoms of pitting edema that occurred as a side effect of chronic heart failure. The prevalence of pitting edema in the patient significantly restricted the mobility of the patient that indirectly impacted upon his mental health. His mental health status is marked by mood swings, feelings of hopelessness and depression. Thus in addition to taking low salt diet and avoidance in taking too much fluid, effective approaches must be followed for the sake of addressing his mental health concerns and in motivating him to lead a better life (McCleary et al., 2013). The non-pharmacologic therapeutic intervention has garnered significant attention in this regard to treat patients with such ailments (Ambrosy et al., 2013). However this motive cannot be achieved alone and the RN must take the help of a counselor to deal with the situation. The cognitive behavioral therapy (CBT) may be resorted to for altering the pattern of thinking and behavior in the person to account for positive changes (Elliot et al., 2014). Research has found out that in conjunction with the relaxation exercises, CBT has the potential to alleviate the depressive symptom in the patients with chronic heart failure as part of the disease management programs (Lundgren, Andersson Johansson, 2015). The nurse attending the patient must work in collaboration with the attending psychological counselor to enhance the QOL in the concerned individual. In contrast to the usual care regime, CBT might be chosen as adjunct therapy to harbor positive outcomes with respect to interventions for treating depression alongside heart failure related self care (Freedland et al., 2015). Thus adopting these strategies and technique Giovanni is likely to be benefited showing stark improvements in his mobility as well as mood elevation. Reviewing and evaluating the information regarding the patients health status through utilization of the Clinical Reasoning Cycle it is evident that the projected interventions are likely to benefit the patient by means of enhancing his quality of living and ameliorating the symptoms that typically represent his acute manifestation of heart failure (Gruppen, 2017). The proper compliance to the therapeutic interventions in the form of medications and other appropriate techniques will ensure the harboring of optimum outcomes in the patient. Nursing skills will reach out to addressing his health both collaboratively and independently thereby paving the way for effective health outcomes. The severity of his symptoms pertaining to chronic heart failure will require him to undertake both short term and long term objectives to maintain a healthy life. The risk assessment carried out pertinent to the patient further provided future implications that need to be reconsidered in making prudent clinical decisions. References Ades, P. A., Keteyian, S. J., Balady, G. J., Houston-Miller, N., Kitzman, D. W., Mancini, D. M., Rich, M. W. (2013). Cardiac rehabilitation exercise and self-care for chronic heart failure. JACC: Heart failure, 1(6), 540-547. Ambrosy, A. P., Pang, P. S., Khan, S., Konstam, M. A., Fonarow, G. C., Traver, B., ... Grinfeld, L. (2013). 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