Rationale for Congestive Heart Failure Nursing Interventions

Hi here is the CLC Assignment . Based on patient health history and discharge orders, 4 of the problems (in page 2) and interventions identified . Pls provide rationale for the interventions in details. I have added Patient history and Discharge order for the patient.

Sallie Mae Fisher’s Health History
and Discharge Orders

Sallie Mae Fisher Health History

Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. During the last 6 months, she has been hospitalized four times for exacerbation of her CHF. She was discharged home last Saturday from the hospital after a 3-day stay to treat increased dyspnea, an 8-pound weight gain, and chest pain.

Ms. Fisher is recently widowed and lives alone. She has a daughter, Thelma Jean, who lives in town but works full time and has family issues of her own. Therefore, family support is limited.

Hospital Discharge Instructions 

• Mountain Top Home Health to evaluate cardio-pulmonary status, medication management, and home safety.
• Medical Equipment Company to deliver oxygen concentrator and instruct patient in use. O₂ at 2 liters per nasal prongs PRN.
• Prescriptions given at discharge:
  • Digoxin 0.25 mg once a day
  • Lasix 80 mg twice a day
  • Calan 240 mg once a day
  • Order written to continue other home meds.

Assignment: Provides rational for interventions identified. Discussion of rationale includes support from outside resources (current evidence-based literature).

Nursing Interventions for Problems Identified

1. Medication Intervention: Provide a written schedule for taking medication as well as a pillbox that can be filled weekly by home health nurse. Call primary MD to clarify Lasix and Digoxin for duplicate therapy. Schedule one nurse visit with patient just to talk about medication. Teach patient with the teach-back method to reinforce importance of taking medication correctly. Identify parameters for certain medications and how to monitor at home (ex-hold Digoxin for pulse <60)

2. Depression/Lonliness: provide emotional support to patient and validate her feelings. Provide resources for social support and activity (ex-senior center, adult programs, bingo) Provide resources on transportation to these activities and events if patient unable to drive. Many adult day programs will pick up members at their home and transport them to and from the day program. Assist patient in becoming a part of these programs if she is interested. Monitor emotional status from week to week, perform a suicide assessment, and keep in contact with primary MD to initiate an antidepressant if needed.

3. Safety Intervention: The key intervention in regards to safety is education. Encourage patient to remove throw rugs or clutter to prevent a fall. Many times patients will modify their homes if education is given on falls and the aftermath of a fall. Encourage personal safety and locking the door. Provide a lock box to hang on the door that the nurse has the code to- to enter the apartment in the event of an emergency. Provide education and information on the use of a life alert or other call device. These can be programmed to call 911 a family member, or the home health agency. Educate on the benefits of oxygen support and how this can make the patient feel better and have an improved quality of life. Educate and encourage patient to report any new symptoms, problems (such as nausea, constipation) to her nurse to help manage symptoms. In addition, educate to report all new medications to the nurse as well.

4. Nutrition Intervention: Provide education on why proper nutrition and hydration is so important, especially with taking medication. Provide a jug or thermos that patient can use to ensure she is taking in enough fluid during the day (but not too much!) and monitor I&O. Assist patient with signing up for meal delivery program (ex-Meals on Wheels) that will deliver a hot meal to the patient every day of the week. Educate on daily weights and help patient keep a log near the scale to record her weights.