In Britain, every nurse is on grade. The grade depends on experience and skill, and each grade has different responsibilities and pay. On the bottom grades are unqualified auxiliary nurses who do the routine work on hospital wards. On the top grades are nursing officer, who are usually administrators.
Auxiliary nurses are on the bottom grades, but student nurses get the lowest pay. However, student don't stay at the bottom of the scale forever. When they qualify, they start working on a middle grade. As they get experience, they can get promotion and move up the ranks to become staff nurse, then sister (charge nurse if a man), and perhaps eventually nursing officer.
Many Nurse work shift, and often they work overtime to earn more money. After basic training, many nurses choose to do further study and become specialists. Nurses can specialize in many different fields, there are triage nurses working in Casualty, and Psychiatric nurses who treat the mentally ill. There are health visitors who visit patients in their own home, practice nurses working in GPs' surgeries, and midwives who deliver babies.
Many of them say they don't get enough pay and respect for the work they do. They say that the work is physically and mentally hard, that they work long hours and get very tired. But they also say that there are many great rewards which have nothing to do with money.
Nursing Care Plan For Heart Failure
Heart Failure also called as Cardiac failure, Congestive Heart Failure (CHF). Heart failure (HF) is a medical condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's metabolic needs.
Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should. It should not be confused with cardiac arrest. So, the Nursing Care Plan for Heart Failure cases are little different with others heart problems.
Heart failure can occur on the left-sided or right-sided of the heart. Left-sided heart failure causes mostly pulmonary sign and symptom, such as shortness of breath, dyspnea on exertion and a moist cough. Right-sided heart failure causes systemic sign, such as edema and swelling, jugular vein distention and hepatomegaly.
The possible causes of heart failure are atherosclerosis, cardiac conduction defects, chronic obstructive pulmonary disease, fluid overload, hypertension, MI, pulmonary hypertension, valvular insufficiency, valvular stenosis.
Nursing Care Plan For Heart Failure :
A. Assessment Findings on Heart Failure Cases
- Left-sided heart failure ; Dyspnea, Crackles, Orthopnea, Paroxysmal noctural dyspnea, Tachypnea, Tachycardia, Gallop rhythm (third or S3 and fourth or S4 heart sound), Fatigue, Anxiety, Arrhythmias and Cough.
- Righ-sided heart failure ; Dependent edema, Weight gain, Fatique, Jugular vein distention, Tachycardia, Gallop rhythm (S3 or S4), Nausea, Anorexia, Hepatomegaly and Ascites.
B. Diagnostic Evaluation
- Left-sided heart failure ;
- ABG levels indicate hypoxemia and hypercapnia.
- Blood chemistry test results reveal decreased potassium and sodium levels and increased BUN and creatinine levels.
- Chest X-ray shows increased pulmonary congestion and left ventricular hypertrophy.
- ECG may show left ventricular hypertrophy or acute ST-T wave changes.
- Echocardiography shows increased size of cardiac chambers and decreased wall motion. Hymodinamic monitoring reveals increased PAP and PAWP and decreased cardiac output.
- Righ-sided heart failure ;
- ABG levels indicate hypoxemia.
- Blood chemistry test results show decreased sodium and potassium levels and inc creatinine levels.
- Chest X-ray reveals pulmonary congestion, cardiomegaly, and pleural effusions.
- ECG may show left and right ventricular hypertrophy or acute ST_T wave changes.
- Echo cardiogram shows increased size of chambers and decreased in wall motion.
- Hemodynamic monitoring show increased right atrial pressure, CVP, and right ventricular pressure and also decrease cardiac output.
C. Nursing Diagnoses
- Excess fluid volume
- Activity intolerance
- Ineffective health maintenance
Due to possible cases above, the best treatment are :
- Low-sodium diet and limited intake of fluid
- Intra-aortic balloon pump (IABP)
- Oxygen therapy (possible intubation and mechanical ventilator)
- Left ventricular assist device (for left-seded heart failure)
- Paracentesis (for right-sided heart failure)
- Thoracentesis (for right-sided heart failure)
There are many of drugs therapy option, such as :
- Analgesic (morphine sulfat IV)
- Angiotensin-converting enzyme (ACE) inhibitor; {captropil (capoten), enalapril (vasotec), lisinopril (prinivil)}
- Beta-adrenergic blocker ; {carvedilol (coreg), metoprolol (lopressor)}
- Cardiac glycoside; digoxin (lanoxin)
- Diuretic; {bumetanide (bumex), furosemide (lasix), metolazone (zaroxolyn), spironolactone (aldactone)}
- Inotropic agent; {amrinone lactate (inocor), dobutamine hydrochloride (dobutrex), dopamine hydrochloride (intropin)}
- Nitrate; {isosorbite dinitrete (isordil), nitroglycerin (nitro-bid)}
- Vasodilator; nitroprusside sodium (nitropress)
D. Planing and Goals of Nursing Care
- The clients will understand how to cope with necessary lifestyle changes.
- The client won't develop preventable complication
- The client will will understand how to continue therapy at home.
E. Nursing Intervention For Heart Failure
- Assess cardiovascular status, vital sign and hemodynamic variable to detect signs of reduced cardiac output.
- Assess respiratory status to detect increasing fluid in the lungs and respiratory failure.
- Keep the client in semi-fowler's position to increase chest expansion and improve ventilation.
- Administer medication as prescribed, to enhance cardiac performance and reduce excess fluids.
- Administer oxygen to enhance arterial oxygenation.
- Measure and record intake and output, Intake greater than output may indicated fluid retention.
- Monitor laboratory test result to detect electrolyte imbalances, renal failure, and impaired cardiac circulation.
- Provide suctioning, if necessary assist with turning and encourage coughing and deep breathing to prevent pulmonary complication.
- Restrict oral fluid to avoid worsening the client's condition.
- Weigh the client daily to detect fluid retention. A weight gain of 2lb (0,9 kg) in 1 day or 5 lb (2,3 kg) in 1 week indicates fluid gain.
- Measure and record the client's abdominal girth. An increased in abdominal girht suggests worsening fluid retention and right-sided heart failure.
- Make sure the client maintains a low-sodium diet to reduce fluid accumulation.
- Encourage the client to express feelings, such as a fear of dying to reduce anxiety.
F. Evaluation of Nursing Care on Heart Failure Disease.
- The client accurately describes recommended dietary restriction and medication regimens.
- The client hasn't experienced complication
- The client verbalizes important sign and symptom to report.
Labels: NCP Heart Disease
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