References Mailings Review View AaBbCcDdEe AaBbCcDdEe AaBbCcD Normal No Spacing
ID: 245633 • Letter: R
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References Mailings Review View AaBbCcDdEe AaBbCcDdEe AaBbCcD Normal No Spacing Heading 1 The home care nurse is seeing a 68-year-old Vietnamese woman for an initial visit. The patient was discharged from the hospital with a diagnosis of congestive heart failure (CHF). The home health nurse notices the patient's blood pressure is elevated, and the patient has a productive cough. The patient speaks very little English. However, the patient's daughter is present and able to interpret. The nurse completes a full health assessment, including a review of medications, and notes that the patient was prescribed a diuretic and a beta-blocker to regulate blood pressure. The daughter shares with the nurse that her mother does not like taking medications and chooses to take herbal remedies instead. Upon assessment, the patient's vital signs are T 98.6 P 76 R 20 BP 160/80, 02 saturation 94%. The patient's lungs are positive for scattered rhonchi in the upper bases, clear in the lower bases, rhonchi clear with a cough. The patient's heart rate is regular with no audible mummers, +2 edema bilateral in the lower extremities. The patient denies pain. 1. Based on the information presented by the patient's daughter, what are the most likely cause of the elevated blood pressure, edema, and rhonchi? 2. What interventions should the nurse incorporate into the plan of care for this patient? 3. What steps does the nurse need to take to become culturally competent? 4. What interventions can the nurse include to provide care that reflects an acceptance of the patient's health and illness beliefs and practices? h (United States)Explanation / Answer
Ans1) causes of elevated blood test are:
Volume overload.
Pressure overload which is caused by obstructive lesions,stenosis or coarctation of aorta.
Decreased contractility which may be caused by myocardial ischemia.due to severe anemia,acidemia,low levels of k,glucose,,ca,mg.,
Main cause she is not taking a medicine diuretics and beta lockers.which can lead to edema due to fluid overload and beta blockers decreases blood pressure.
2)ans) plan of care: interventions,
1) health assessment.:auscultate breath sounds,
2) instruct patient in effective coughing,deep breathing to clears airways and facilitate oxygen delivery.
3) maintain chair or bed rest , with head of bed elevated 20 to 30 degrees,semi Fowler's position.support arms with pillows. To promote maximum lung inflation.
4) administration of oxygen to increases alveolar oxygen concentration,which may reduce tissue hypoxemia.
5) administration of diuretics to reduce alveolar congestion,enhancing gas exchange.
6) encourage breathing and coughing excercise by using spirometry.
7) health education given for importance of medications.
4)ans: after care the patients free from symptoms.
Health education and psychological support given to the patient .
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