Nursing plan

Nursing Care Interventions for Managing patients presenting With Congestive Heart Failure
The subjective and objective parameters of the patient reflected that she was suffering from congestive heart failure (CHF) (McMurray et al., 2012). This article reflects a review on the nursing care interventions (including pharmacological and non-pharmacological interventions) that should be extended to the concerned individual.
Implications of the Pharmacological Interventions
Furosemide: It is a loop diuretic that promotes diuresis by inhibiting the sodium-chloride (Na+/ Cl-) co-transporter which is located at the ascending limb of Henle’s loop. This drug is used to manage fluid retention in patients presenting with CHF. The reduction in fluid volume reduces both preload and afterload on the ventricles that prevents further hypertrophy of the ventricles (McMurray et al., 2012).
Enalapril maleate: It is an ACE (Angiotensin-1 converting enzyme) inhibitor that prevents the formation of Angiotensin-II. Angiotensin-II acts on adrenal cortex to potentiate the release of aldosterone. Aldosterone is a mineralocorticoid group of hormone that mediates sodium reabsorption through the ENaC (epithelial sodium channels) located in the Henle’s loop. As a result, the reabsorption of sodium along with water increases the blood volume. On the contrary, administration of enalapril maleate inhibits such effects and favor natriuresis. It is used along with loop diuretics to reduce fluid retention that mitigates the rise in preload and afterload on the ventricles (McMurray et al.

, 2012).
Metoprolol: It is a beta-2 adrenergic receptor antagonist and acts by exerting negative chronotropic, ionotropic, dromotropic, and bathmotropic effects on the myocardium. The drug acts by inhibiting the actions of the sympathetic nervous system (SNS) on the heart. Studies suggest that sympathetic activity significantly increases during CHF (Metra & Teerlink, 2017). Therefore, metoprolol attenuates the effect of SNS and prevent ventricular remodeling which are the hallmarks of CHF.
Intravenous Morphine Sulfate: IV-morphine sulfate can reduce the respiratory drive in CHF patients by inhibiting chemoreceptor sensitivity. On the other hand, morphine promotes pooling of blood into the peripheral circulation. Both of these actions reduce the work done by the heart that prevents the deterioration of cardiac function in CHF patients. Moreover, IV-morphine can reduce anxiety and pain that further helps to reduce the episodes of tachypnea and tachycardia.
Causes of Heart Failure
The four causes of heart failure are cardiac arrhythmia, hypertension, left ventricular cardiomyopathy, and coronary artery disease.
Cardiac arrhythmia: change in rhythmicity of the heart due to fluctuations in the electrical impulse.
Hypertension: High blood pressure refers to the amount of pressure that blood has to exert upon the lateral wall of arteries to overcome the peripheral resistance.
Left ventricular cardiomyopathy: An increase in size of the left ventricles caused due to higher after-load to the left ventricles.
Coronary artery disease: Narrowing of the diameter of coronary arteries due to the deposition of atherosclerotic plaques or thrombus.
Nursing Care Plan for the Concerned Individual
Apart from initiating the pharmacological interventions as per guidance of the attending physician, nurses should advocate for a PTCA or CABG based on the results of imaging studies (if they are available). Mrs. J should be briefed regarding the pathogenesis of her disease. She should be motivated to control her body weight and abstain from smoking. Such initiatives would help to mitigate the risks of heart failure. Moreover, she should be sensitized to comply with her medications (such as anti-hypertensive medications, blood-thinners, and anti-angina medications if prescribed). Finally, she should be advised to inculcate healthy lifestyle behaviors such as engaging routine physical exercise and consuming fat-restricted diet (if found to be dyslipidemia). The primary objective of nursing should be to stabilize the patient by reducing the episodes of tachypnea and fluid retention through pharmacological intervention. The concerned nurse should ensure effective gas exchange in the patient by initiating supplemental oxygen therapy and bronchodilators to ensure patency of the airways. The nurses should monitor the signs and symptoms of orthostatic hypotension and altered peripheral tissue perfusion that might accompany pharmacological interventions (Metra & Teerlink, 2017). Apart from reducing anxiety and pain through the administration of morphine sulfate, nurses should undertake a person-centric approach in reducing apprehensions and fear in the concerned patient. Finally, the head of the patient’s bed should be lifted by 20-30 cm to reduce venous return and improve sleep. References
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A (2012). “ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012”. European Heart Journal. 33, 1787–1847. 
Metra, M & Teerlink, JR (2017). “Heart failure”. Lancet. 390(10106), 1981–1995