Hypertension, chronic heart failure, and sleep apnea:Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

Subjective Data

1.      Is very anxious and asks whether she is going to die.

2.      Denies pain but says she feels like she cannot get enough air.

3.      Says her heart feels like it is “running away.”

4.      Reports that she is so exhausted she cannot eat or drink by herself.

 

Objective Data

1.      Height 175 cm; Weight 95.5 kg

2.      Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58

3.      Cardiovascular: Distant S1, S2, S3, S4 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation

4.      Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%

5.      Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin

 

Hypertension, chronic heart failure, and sleep apnea

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

1.      IV furosemide (Lasix)

2.      Enalapril (Vasotec)

3.      Metoprolol (Lopressor)

4.      IV morphine sulphate (Morphine)