Nursing interventions that would be appropriate for Ms J during her admission to the ICU would include the following: Continuous monitoring of VS and oxygen saturation after nasal O2 is applied - if saturations do not improve change to mask and do not rule out possible intubation - elevate HOB to a semi-fowlers position to facilitate easier effort of breathing  Assess for changes in her alertness or signs of confusion or hypoxia  Observe rhythm for increased ventricular rate with atrial fib and deterioration in cardiac status with ectopy or onset of chest pain Provide an environment that allows for rest and decreased anxiety – organize nursing care to facilitate rest periods Monitor intake and output for cardiac stability as well as dehydration from the onset of the flu Auscultate chest more frequently for  breath sounds to determine improvement or deterioration in status Administer medications as ordered and  assess for prn meds to facilitate reduction in fever, generalized achiness from flu, decrease anxiety and promote rest Rationale for the following meds (“Heart Failure Treatments and Drugs”, 2017):   LASIX IV – Produces diuresis in the kidneys and dilation in the venous system to promote a preload reducing effect that is seen within minutes once administered.  Promotes excretion of water from the body and decreases fluid in the lungs to improve breathing  VASOTEC – an Angiotensin-Converting Enzyme (ACE) inhibitor is a vasodilator that increases the blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. LOPRESSOR – A beta blocker that reduces the symptoms of oxygen demand and myocardial ischemia of heart failure, improves the pumping action, and lowers the heart rate and blood pressure. Also increases diastolic relaxation to allow for the heart to fill properly due to wall motion stiffness.   MORPHINE IV – Induces vasodilation and increases venous return to the heart, acts as a mild arterial dilator, decreases myocardial oxygen consumption, centrally suppresses symptoms of breathlessness, decreases anxiety and reduces pain. Four CV conditions that may lead to heart failure; what medical/nursing interventions can prevent the development of heart failure in each condition: Coronary Artery Disease/and MI  is the most common cause of heart failure in which the arteries to the heart that supplies blood become narrowed or blocked.  When blood flow is completely blocked the heart muscle suffers damage and blood supply is reduced and the area around the muscle and blockage dies or suffers loss of blood flow.  If the damage affects the pumping ability, heart failure develops.  Preventative measures to avoid CAD/MI are the lifestyle changes that slow the progression of atherosclerosis or avoided – patient teaching and education regarding a balance diet, exercise, smoking cessation, controlling BP and cholesterol levels.  Patients that have developed CAD should consider the regime of taking an ASA dail.

1. Nursing interventions that would be appropriate for Ms J during
her admission to the ICU would include the following:
Continuous monitoring of VS and oxygen saturation after nasal
O2 is applied - if saturations do not improve change to mask
and do not rule out possible intubation - elevate HOB to a semi-
fowlers position to facilitate easier effort of breathing
Assess for changes in her alertness or signs of confusion or
hypoxia
Observe rhythm for increased ventricular rate with atrial fib
and deterioration in cardiac status with ectopy or onset of chest
pain
Provide an environment that allows for rest and decreased
anxiety – organize nursing care to facilitate rest periods
Monitor intake and output for cardiac stability as well as
dehydration from the onset of the flu
Auscultate chest more frequently for breath sounds to
determine improvement or deterioration in status
Administer medications as ordered and assess for prn meds to
facilitate reduction in fever, generalized achiness from flu,
decrease anxiety and promote rest
Rationale for the following meds
(“Heart Failure Treatments and Drugs”, 2017):
LASIX IV – Produces diuresis in the kidneys and dilation in
the venous system to promote a preload reducing effect that is
seen within minutes once administered. Promotes excretion of
water from the body and decreases fluid in the lungs to improve
breathing
VASOTEC – an Angiotensin-Converting Enzyme (ACE)
inhibitor is a vasodilator that increases the blood vessels to
lower blood pressure, improve blood flow and decrease the
workload on the heart.

2. LOPRESSOR – A beta blocker that reduces the symptoms of
oxygen demand and myocardial ischemia of heart failure,
improves the pumping action, and lowers the heart rate and
blood pressure. Also increases diastolic relaxation to allow for
the heart to fill properly due to wall motion stiffness.
MORPHINE IV – Induces vasodilation and increases venous
return to the heart, acts as a mild arterial dilator, decreases
myocardial oxygen consumption, centrally suppresses symptoms
of breathlessness, decreases anxiety and reduces pain.
Four CV conditions that may lead to heart failure; what
medical/nursing interventions can prevent the development of
heart failure in each condition:
Coronary Artery Disease/and MI
is the most common cause of heart failure in which the arteries
to the heart that supplies blood become narrowed or blocked.
When blood flow is completely blocked the heart muscle suffers
damage and blood supply is reduced and the area around the
muscle and blockage dies or suffers loss of blood flow. If the
damage affects the pumping ability, heart failure develops.
Preventative measures to avoid CAD/MI are the lifestyle
changes that slow the progression of atherosclerosis or avoided
– patient teaching and education regarding a balance diet,
exercise, smoking cessation, controlling BP and cholesterol
levels. Patients that have developed CAD should consider the
regime of taking an ASA daily, beta blockers to reduce the
workload of the heart, routine follow-ups with MD to prevent
further advancement of heart failure. Proactive with testing for
cardiac catheterization for stent placement and evaluation of
coronaries/heart function (Copstead& Banasik, 2012).
Cardiomyopathy
is a general term describing disease of the heart muscle. Even
though it can be caused by other heart related issues the heart
muscle cannot withstand the workload and heart failure

3. develops. Management normally is the treatment with beta
blockers and calcium antagonists; both reduce oxygen
consumption and slow the heart rate. Patients with
cardiomyopathy are at risk for atrial fib in which treatment and
education involves the patient understanding the rhythm, the
incidence of stroke with a.fib, and treatment such as
cardioversion and medications, other preventative measures
focused on reducing symptoms include following a weight loss
program, reducing alcohol intake andmoderate exercise.
Heart Valve Disease
forces your heart to work harder to keep blood flowing in the
correct direction. The valves open and close during diastole
and systole and prevent backflow of leakage of blood back into
the chambers. A damaged valve can be due to a heart defect,
CAD, or a previous MI that involved the valve areas such as
papillary muscles or chordae tendineae. Infection known as
endocarditis can cause vegetation and damage the valves.
Treatment with antibiotics and preventative measures such as
good personal hygiene – dental care is important.
Hypertension
is another common cause of heart failure. High blood pressure
causes the heart to work harder to pump blood even at rest and
the muscle becomes stiff with the inability to pump effectively.
Eventually the heart cannot keep up and symptoms of heart
failure over time develop. Education is important to teach
patient about medications – Diet with foods low in sodium,
healthy choices from the food groups, and exercise program for
maintaining weight. Medical tx may include the use of thiazide
diuretics, beta blockers, ACE inhibitors or other meds per the
MD’s prescribing (Riley, J. 2015).

4. Four nursing interventions that can prevent problems caused by
multiple drug interactions in older patients – provide rationale
Avoiding what is known as “polypharmacy” in which multiple
meds are taken to manage coexisting health issues by multiple
healthcare providers. It is important to review each visit the
current list of prescribed meds, OTC and supplements for
possible duplicates, adverse reactions, or over-dosing (ANA,
2010).
Proper medication reconciliation at time of admission to
hospital and at discharge for any changes. Upon admission
many times physicians are unaware of all medications the
patient is taking when admitted; at discharge the list should be
updated in the discharge papers and reviewed with patients/
family members taking note the correct med, dosage is
understood.
Practice habits using the OTC pill organizers that list the 7
days, am and pm for dispensing meds. This routine will assist
in keeping the patient compliant in taking correct medication
and an easy tool to identify the meds has been taken as
prescribed. Keep pill box in place that is easily visible. Keep as
simple as possible (ANA, 2010).
Avoid doctor shopping and using multiple pharmacies. Many
primary care physicians hand off patients to specialty practices
in which further medications are prescribed or the patient may
request an additional med that he no longer takes and is given.
Patients may have several pharmacies they use for shopping or
who may home deliver. A monthly visit by home health is an
option or follow up with a family member that oversees family
care for evaluation.
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