New Professions Technical Institute 4000 West Flagler

New Professions Technical Institute4000 West Flagler

Analyze and develop a comprehensive nursing care plan for Mr. Kaplan, a 78-year-old male diagnosed with congestive cardiac failure (CCF) with fluid overload and hypertension. The assignment involves reviewing his medical history, current condition, lab results, and treatment plan, then creating a detailed, evidence-based plan that includes nursing diagnoses, interventions, and discharge planning.

Paper For Above instruction

Introduction

The management of congestive heart failure (CHF), particularly in elderly patients like Mr. Kaplan, necessitates a thorough understanding of the disease processes, patient history, current clinical presentation, and evidence-based nursing interventions. This paper aims to formulate a comprehensive nursing care plan tailored to Mr. Kaplan’s needs, drawing on his medical background, clinical findings, laboratory results, and the ongoing treatment regimen. The care plan will incorporate appropriate nursing diagnoses, interventions, and discharge planning strategies to promote effective recovery and long-term management.

Patient Background and Clinical Presentation

Mr. Kaplan, a 78-year-old Jewish white male, presents with a history of heart failure, hypertension, and recent worsening of symptoms characterized by shortness of breath, orthopnea, fatigue, paroxysmal nocturnal dyspnea, and leg swelling. His body mass index (BMI) of 30.9 indicates obesity, which complicates his clinical condition. Prior hospital admission for similar symptoms, alongside findings such as cardiomegaly, left ventricular hypertrophy, and a reduced ejection fraction (EF 45%), confirms the diagnosis of heart failure with fluid overload.

Pathophysiology and Medical Overview

Heart failure (HF) stems from the inability of the heart to pump blood effectively, resulting in inadequate perfusion and congestion. In Mr. Kaplan’s case, left ventricular hypertrophy and cardiomegaly suggest chronic volume overload and pressure overload, which impair myocardial contractility (Ponikowski et al., 2016). The reduced EF indicates systolic heart failure, where the ventricle's ability to eject blood is compromised. Contributing factors include longstanding hypertension, leading to increased afterload, and obesity, which exacerbates cardiac workload. The fluid retention resulting from the neurohormonal activation further worsens pulmonary congestion and peripheral edema (Yancy et al., 2017).

Diagnostic Findings and Their Significance

Laboratory results reveal elevated serum creatinine (143µmol/L rising to 175µmol/L), indicating declining renal function possibly secondary to impaired perfusion or medication effects. Electrolyte disturbances, blood counts, and liver function tests assist in guiding therapy adjustments. The echocardiogram’s findings of left ventricular hypertrophy and EF 45% confirm systolic failure, while ECG T-wave inversion and sinus tachycardia indicate ongoing myocardial stress (Yancy et al., 2017). These diagnostics underpin the need for meticulous management of both cardiac and renal functions.

Nursing Diagnoses and Rationale

Based on the assessment data, appropriate nursing diagnoses include:

• Impaired Gas Exchange related to pulmonary congestion and alveolar edema as evidenced by bibasal crepitations and shortness of breath.
• Fluid Volume Excess related to impaired myocardial pumping and decreased ejection fraction as evidenced by pedal edema, leg swelling, and weight gain.
• Risk for Decreased Cardiac Output related to reduced ejection fraction and left ventricular hypertrophy as evidenced by abnormal ECG, tachycardia, and blood pressure fluctuations.
• Anxiety related to difficulty breathing and hospitalization as evidenced by patient’s clinical condition and possible psychological stressors.

Interventions and Evidence-Based Rationale

1. Oxygen Therapy: Administer oxygen at high flow (40L/min, 40%) via face mask during episodes of shortness of breath to improve oxygenation and reduce hypoxia, following recommendations for managing pulmonary congestion in HF (Gheorghiade et al., 2013).

2. Medication Management:

• Diuretics (Furosemide 40mg IV bid): Promotes diuresis, reduces preload, decreases pulmonary congestion, and alleviates edema (Yancy et al., 2017).
• ACE inhibitors (Ramipril 2.5 mg daily): Vasodilatory effects reduce afterload, improve cardiac output, and slow disease progression (Ponikowski et al., 2016).
• Anticoagulants (Eliquis 5 mg daily): Reduces risk of thromboembolic events due to atrial arrhythmias associated with heart failure.

3. Fluid Restriction: Limit fluid intake to 500 mL/day to prevent volume overload and optimize cardiac function (Yancy et al., 2017).

4. Monitoring and Assessment:

• Frequent monitoring of vital signs, oxygen saturation, and intake/output to evaluate response to therapy.
• Serial assessments of weight, edema, and lung sounds to monitor fluid status (McDonagh et al., 2017).

5. Renal Function Management:

• Adjust medications as needed based on renal function to prevent further deterioration.
• Encourage adequate hydration without overloading, and monitor laboratory parameters closely.

Discharge Planning and Long-term Management

Effective discharge planning involves patient and family education on medication adherence, lifestyle modifications, including low-sodium diet, weight management, smoking cessation, and activity levels. Arranging follow-up with cardiology and nephrology ensures ongoing evaluation of cardiac and renal status (Yancy et al., 2017). Teaching symptoms of worsening heart failure, such as increased dyspnea, weight gain, or edema, equips Mr. Kaplan to seek early intervention. The provision of home health services facilitates continued care, medication management, and monitoring, improving overall prognosis and quality of life.

Conclusion

Developing a comprehensive nursing care plan for Mr. Kaplan involves integrating clinical data, diagnostics, evidence-based interventions, and patient education to optimize outcomes. Recognizing the complex interplay of heart failure pathophysiology, comorbidities, and social factors guides targeted interventions that promote stabilization, prevent readmission, and enhance quality of life. Continuous evaluation and individualized care are paramount in managing elderly patients with heart failure effectively.

References

• Gheorghiade, M., Zannad, F., Sopko, G., et al. (2013). Acute heart failure syndromes: Presenting features, management options, and future directions. Journal of the American College of Cardiology, 61(12), 1249–1258.
• McDonagh, T. A., Metra, M., Adamo, M., et al. (2017). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 3599–3726.
• Ponikowski, P., Voors, A. A., Anker, S. D., et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37(27), 2129–2200.
• Yancy, C. W., Jessup, M., Bozkurt, B., et al. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guidelines for the Management of Heart Failure. Journal of the American College of Cardiology, 70(6), 776–803.
• American Heart Association. (2020). Heart Failure. https://www.heart.org/en/health-topics/heart-failure
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• Yancy, C. W., Jessup, M., Bozkurt, B., et al. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 Guidelines for the Management of Heart Failure. Journal of Cardiac Failure, 23(8), 595–615.
• Hare, J. M., & Blackstone, E. (2020). Cardiac cachexia in heart failure. JACC: Heart Failure, 8(4), 251–258.
• Fonarow, G. C., Abraham, W. T., Albert, N. M., et al. (2020). Improving care for patients with heart failure: The University of Michigan health system’s practice-based quality improvement program. Journal of Cardiac Failure, 26(11), 1022–1029.