Advanced Care Plan Part B Revision

Running head: ADVANCED CARE PLAN, PART B

Advanced Care Plan, Part B

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ADVANCED CARE PLAN, PART B 2

Advanced Care Plan, Part B

Pathophysiology of CCF (referenced)

The syndrome of CHF arises as a consequence of an abnormality in cardiac structure,

function, rhythm, or conduction. It is an ongoing medical condition in which the muscles of heart

become weakened and do not work as normal. It may happen as of myocardial ischemia,

valvular dysfunction, coronary artery disease and hypertension. Due to weakened heart muscle

the cardiac output to decreases (Nicholson, 2014). This leads to inadequate perfusion of tissue,

and leads to insufficient supply of oxygen. The main blood pumping chamber called the

ventricles may get enlarged or become thicker, and either lose ability to squeeze or contract or

relax as they should. This the foremost cause of fluid retention in various body parts especially

legs, abdomen and lungs (PubMed, n.d.).

Clinical Reasoning Cycle

Table 1: Clinical Nursing Cycle

Nursing Diagnoses

Short-term goals

Long-term goals

Oedema

Reduction of fluid retention

in the body

Improve the ability of the

patient to walk properly.

Hypertension

Reduction in the blood

pressure levels

To reduce chances of

hypertension developing into

an intermediate stage.

ADVANCED CARE PLAN, PART B 3

Shortness of breath

Improvement in the level of

air movement through the

airways.

To enable the patient breath

properly, eventually and

increase the rate of oxygen

supply.

Nursing Problems Evidenced in the Patient

M.G. has edema, evidenced by the increased size of her legs and medical tests confirming

the same. The increase in the amount of fluid in her body has also led to an increase in her body

weight (Stoddart & Evans, 2017). As a result, she has gained about 5 years since she was

discharge from hospital.

M.G also suffers from hypertension. The increase in the hypertensive problem is as a

result of her failure to adhere to the salt restriction that she was given at the hospital. She was

also lees keen on adhering to the specific medication she was given at the hospital. As a result,

there was a high chance for the increased blood pressure (Santschi et al., 2014).

The element of shortness of breath is also another problem that would need to be well-

handled in the patient (Swan et al., 2015). The shortness of breath may be caused by heart and

lung problems that are normally brought about by the hypertensive condition that he has. The

increased rate of blood flow could, therefore, create the need for more oxygen supply.

ADVANCED CARE PLAN, PART B 4

Nursing interventions for the health problems and Evaluation

Intervention and Evaluation for Oedema

Intervention 1

There is the need for exerting fluid restrictions in order to reduce the chance of build-up

of the body fluids. The rationale for the exercise will be to reduce the amounts of fluids within

the body to improve the physiological processes of the patient. One evaluation, the exercise is

important as it helps to reduce the amount of fluids in the body evidenced by the reduced size of

the leg.

Intervention 2

It is important to limit the amount of sodium that may be taken by the patient (Cicolini et

al., 2014). The goal of the activity will be to ensure that the patient has a balanced intake as well

as output, which will be critical towards maintaining her body weight. The rationale of the

practice will be majorly to reduce upon the amount of fluid that s retained in the body. Some

balanced aspect of osmotic pressure will be attained in the body. On evaluation, the intervention

has led to reduced amounts of body fluids in the body of the patient, as shown by the reduction in

the size of her leg.

Intervention 3

It will be imperative to monitor the amount of fluid taken in by the patient. The goal of

the activity would be to ensure that the amounts of fluids taken are within the required amount

(Doenges, Moorhouse & Murr, 2016). The rationale for the exercise is to enhance the level of

compliance with the drugs that she has been given to deal with the health problem. One

ADVANCED CARE PLAN, PART B 5

evaluation, the patient achieves better outcomes with respect to the efficacy of hypertensive

drugs given.

Intervention 4

There is the need for M.G. to take diuretics, such as Hydrochlorothiazide. The goal of the

activity would be to generally reduce upon the amount of fluids that are present within the

patient. Generally, the rationale of the activity is to help in the excretion of the excess fluids

(Allen et al., 2014). As a result, the patient is able to attain the best outcome with respect to the

reduction in the amount of fluids that may be present in the patient. The intervention is important

as evidenced by the reduced size of the leg in the patient (Bodenheimer & Bauer, 2016). With

continued action, there is a high possibility of M.G. attaining a better health outcome and

regaining her ability to walk properly.

Intervention 5

There is the need for the nurse to advice the patient on a weight loss program (Allen et

al., 2014). The exercise will be important as it will help to remove the excess weight that is

brought about by the huge amounts of body fluids that she has. The exercise is a success as

shown by the reduced body weight and she can now manage to walk properly.

Intervention 6

The patient, with the assistance of the nurse will raise her legs three to four times a day.

The rationale will be to improve the rate of blood circulation in the body (Allen et al., 2014). The

aim will be to ensure that that the patient is able to reduce upon the amount of body fluids

retained. On evaluation, the intervention has helped to reduce upon the amount of body fluids in

the patient.

ADVANCED CARE PLAN, PART B 6

Intervention and Evaluation for Hypertension

Intervention 1

The intervention for hypertension will involve the reduction in the elevated blood levels

in the body by avoiding excessive exercise (Bodenheimer & Bauer, 2016). The rationale of the

intervention will to reduce the chances of worsening the hypertensive situation of the M.G. and,

therefore, ensure that she is able to achieve a more worthwhile life. On evaluation, the

intervention is important as it has made the patient have lower blood pressure levels at 132/86.

Intervention 2

It is important to monitor the blood pressure in the patient. The goal of the activity will be

to ensure that any rise in the blood pressure is quickly noted (Stoddart & Evans, 2017). The

rationale of the activity is to ensure that the right approaches are put towards reducing upon the

level of blood pressure in M.G in a timely fashion. On evaluation, it has helped to determine

whether there is the need to administer large amounts of hypertension drugs to deal with the

health problem.

Intervention 3

It is necessary to administer antidiuretics. The goal of the activity will be to reduce the

amount of fluids in the patient. The rationale for the activity will be to decrease in the level of

blood pressure present (Bodenheimer & Bauer, 2016). The intervention is successful as it has

helped to reduce the resistance of the walls of the arteries, evidenced by the low rate of blood

pressure in the patient.

ADVANCED CARE PLAN, PART B 7

Intervention 4

The nurse may also need to provide the patient with proper health education on the need

to ensure that she has peaceful environment that is free of stressors. The goal of the activity

would be to ensure that the patient is able to avoid some of the risk factors that might play a

major role towards the increase of the blood pressure levels present in the patient (Conn et al.,

2015). The rationale of the activity would be to ensure that the blood pressure level in the patient

is put at bare minimum. On evaluation, the process is a success as it ensures that the patient is

able to engage in her day-to-day activities without having much fear of some harmful outcomes

coming about.

Intervention 5

The nurse will need to advice the patient on the appropriate diet that she would need to

stick to. The aim will be to reduce upon the extent of blood pressure in her body (Stoddart &

Evans, 2017). With the controlled levels of blood pressure, there will be the increased chances of

attaining better control of her state of health. The exercise is a success as it puts the blood

pressure of the patient at low levels.

Intervention 6

The patient will need to conduct regular exercise. The action will be important in

controlling the body weight of the patient (Stoddart & Evans, 2017). To that end, it will be

imperative towards reducing the extent of blood pressure in the patient. It evidenced by the

improvement in the rate of blood supply of the patient.

ADVANCED CARE PLAN, PART B 8

Intervention and Evaluation for Shortness of Breath

Nursing Intervention 1

There is the need to improve on the breathing rate of the patient. The rationale for the

exercise will be to ensure that the patient is able to take in oxygen in the required amounts. As a

result, she will be in a position to regulate her heart beat and control the amount of oxygen

supply in her body. As an evaluation, the intervention will lead to an increased supply of oxygen

in the body.

Nursing Intervention 2

There is the need to assess the level of oxygen saturation of the patient. On the advice of

the physician, the patient will be placed on the bipap (He et al., 2014). The level of oxygen

saturation in the patient will, therefore, need to be monitored every 30 minutes. It will be to

establish the extent of the shortness of breath problem that the patient might be having. The

rationale of the activity will be to ensure that the right measures are applied to reduce upon the

problem. One evaluation, the intervention improves has enabled the physician to accurately

determine the oxygen needs of the patient.

Nursing Intervention 3

The intervention will be based on improving the breathing rate of the patient is the use of

demonstration to demonstrate holding end inspiration and slow inhalation to the patient. The goal

of the exercise will be to enable the patient have the ability to control her breathing rate (Brown

et al., 2017). She will also have the ability to increase upon the level of flow of oxygen in his

blood. The rationale for the exercise will be to promote the aspect of deep inspiration in the

patient. The rationale of the exercise will be to ensure that M.G is able to breath effectively and

ADVANCED CARE PLAN, PART B 9

increase upon the rate of flow of blood in her body. One evaluation, the intervention has

achieved proper control of rate of supply of blood in the body, evidenced by slowed down

pulses.

Nursing Intervention 4

Another exercise will involve the utilization of the incentive spirometer to improve upon

the rate of breathing of the patient. The goal of the exercise will be to reduce upon the

intermittent breathing problems in the patient. The rationale of the exercise will be to increase

the level of prolonged expiration (Bodenheimer & Bauer, 2016). Through the process, there is a

chance that the patient will have an increased inflow of air moving through the airways. The

exercise will also help to prevent upon the level if air trapping that might take place in the

patient. As a result, there is a chance that it would improve upon the quality of the health of the

patient. The shortness of breath will, therefore, not compound with the hypertensive situation

that she is exposed to.

Intervention 5

The assessment of the airways of the patient is important. It would also indicate whether

there are some underlying problems that might be behind the problem, such as heart and chest

problems, as well as the existence of COPD in the patient (Stoddart & Evans, 2017). The

intervention is a success as it has helped show that the patient is not experiencing a case of

COPD.

Intervention 6

There may also be the need for the patient to use an inhaler to increase upon the rate of

air supply into the airways (Stoddart & Evans, 2017). The action will help to reduce upon the

ADVANCED CARE PLAN, PART B 10

chances of shortness of breath in the patient. It is evidenced to be successful by enabling the

patient to breath properly.

Reflection

The interventions applied to reduce oedema, blood pressure and shortness of breath in the

patient have managed to bring about better outcomes. The outcome is evidenced by the blood

pressure of 132/86. Although the indices still portray an indication of blood pressure in the

patient, it is still within the required levels, given M.G is hypertensive. The intervention is,

therefore, effective towards reducing upon the negative health conditions that the patient

experiences. Although hypertension cannot be completely cured, it can be kept at levels that

would not be quite detrimental to the patient. The amount of fluid retention in the patient has also

reduced significantly, shown by the ability of the patient to walk. The improvement on the

breathing rate of the patient is critical towards the reduction of the shortness of breath in the

patient. Through the use of the incentive spirometer, there is a chance of properly dealing with

the shortness of breath problem that may be in existent in the patient.

ADVANCED CARE PLAN, PART B 11

References

Allen, J. K., Himmelfarb, C. R. D., Szanton, S. L., & Frick, K. D. (2014). Cost-effectiveness of

nurse practitioner/community health worker care to reduce cardiovascular health

disparities. The Journal of cardiovascular nursing, 29(4), 308.

Bodenheimer, T., & Bauer, L. (2016). Rethinking the primary care workforce—an expanded role

for nurses. New England Journal of Medicine, 375(11), 1015-1017.

Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical Nursing:

Assessment and Management of Clinical Problems. Elsevier Health Sciences.

Cicolini, G., Simonetti, V., Comparcini, D., Celiberti, I., Di Nicola, M., Capasso, L. M., ... &

Manzoli, L. (2014). Efficacy of a nurse-led email reminder program for cardiovascular

prevention risk reduction in hypertensive patients: a randomized controlled

trial. International journal of nursing studies, 51(6), 833-843.

Conn, V. S., Ruppar, T. M., Chase, J. A. D., Enriquez, M., & Cooper, P. S. (2015). Interventions

to improve medication adherence in hypertensive patients: systematic review and meta-

analysis. Current hypertension reports, 17(12), 94.

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nursing diagnosis manual: Planning,

individualizing, and documenting client care. FA Davis.

He, J., Zhang, Y., Xu, T., Zhao, Q., Wang, D., Chen, C. S., ... & Peng, Y. (2014). Effects of

immediate blood pressure reduction on death and major disability in patients with acute

ischemic stroke: the CATIS randomized clinical trial. Jama, 311(5), 479-489.

Nicholson, C. (2014). Chronic heart failure: pathophysiology, diagnosis and

ADVANCED CARE PLAN, PART B 12

treatment. Nursing Older People, 26(7), 29-38. doi:10.7748/nop.26.7.29.e584.

PubMed (n.d.). Pathology of conjestive heart failure. Retrieved from :

https://www.ncbi.nlm.nih.gov/pubmed/4014051

Santschi, V., Chiolero, A., Colosimo, A. L., Platt, R. W., Taffé, P., Burnier, M., ... & Paradis, G.

(2014). Improving blood pressure control through pharmacist interventions: a meta-

analysis of randomized controlled trials. Journal of the American Heart Association, 3(2),

e000718.

Stoddart, G. L., & Evans, R. G. (2017). Producing health, consuming health care. In Why are

some people healthy and others not? (pp. 27-64). Routledge.

Swan, M., Ferguson, S., Chang, A., Larson, E., & Smaldone, A. (2015). Quality of primary care

by advanced practice nurses: a systematic review. International Journal for Quality in

Health Care, 27(5), 396-404.

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