Question

what is action plan for 1)increase shortness of breath 2) increased fatigue experience

a 60-year-old male who has hypertension and heart failure. He should arrive shortly. Mr. Stone was seen a couple of years ago by Dr. Shelton and was originally prescribed hydrochlorothiazide for hypertension. Mr.Stone reports that he hasn’t taken the medications as directed. He’s not taking any other medications at present. And he saw Dr. Shelton today because he’s experiencing increasing fatigue with shortness of breath, paroxysmal nocturnal dyspnea, and has noticed recent weight gain. An ECG and chest X-ray were performed, and he had blood drawn for laboratory tests in the office. He’s alert and oriented, his blood pressure was 168/96 Temp 98.4 Pulse 98 RR22 lung sound: Crackly recording. Rice crispiest sounds O2 90%on room air and increased to 94% with oxygen at two liters per minute per cannula nasal The nurse administered enalapril 5mg PO to Mr. Stone Patient: I went back to the doctor because I became short of breath just going up a flight of stairs. I was feeling more tired than usual. I haven’t been sleeping well either, even with an extra pillow. The doctor said something about heart failure, so that’s why I’m here.

Answer 1

Hypertension : The disease or disorder of abnormally high blood pressure is called Hypertension.

Heart failure : The chronic inability of the heart to pump a sufficient amount of blood throughout the body , leading to a pooling of blood and shortness of breath.

Action plan : Increased shortness of breath

* Monitor vital signs

* Assess for abnormal breath sounds , crackling sound indicates the presence of fluid in the airways .

* Position the patient in semi- Fowler's position to expand chest volume.

* Administer medications as per physician's order:

Antihypertensives:

ACE inhibitors ( Angiotensin Converting Enzyme Inhibitors) ; Enalapril, captopril

Beta blockers; To improve cardiac function and to reduce arrhythmias.(Carvedilol, metoprolol)

Diuretics

Drugs that increase urinary output, helps in relieving the fluid retention, swelling and pulmonary congestion there by reducing the breathing difficulty. ; Furosemide.

Digoxin : To strength heart muscles

Blood thinning medications: Heparin or warfarin, to prevent blood clots.

Nitrates ; to reduce chestpain

* Administer supplemental oxygenation to reduce dyspnoea

Action plan : Increased fatigue experience

* Assist the patient in Ambulation and self- care needs.

* Provide a comfortable Environment with appropriate temperature and humidity., extremes may increase fatigue.

* Provide a calm and quiet environment to ensure adequate rest and sleep.

* Administration of supplemental oxygen to prevent hypoxia, there by preventing fatigue.

* Arrange the needed articles and patient's things in an easy reach to prevent fatigue.

* Promote overall health measures like healthy meal and activity as per indicated.

* Mix the activity periods with the rest periods.

* Encourage the patient to have a positive attitude .

*Elevate the head of the bed for maintaining an open air way.

* Medications to treat heart failure ( as mentioned above) also helps to reduce fatigue by ensuring the adequate oxygen to tissues.