This document discusses acute decompensated heart failure. It outlines nursing interventions for a patient with acute decompensated heart failure which include supplemental oxygen, CPAP, breathing treatments, pulse oximetry monitoring, and lab tests. It also discusses drug therapies for heart failure like diuretics, ACE inhibitors, beta blockers, and opioids which aim to decrease preload and afterload. The document also covers risk factors for acute decompensated heart failure like coronary artery disease, hypertension, cardiomyopathy, and arrhythmias. It emphasizes accurate administration of medications, patient education on compliance, and avoiding herbals or old medications.

1. Discussion: Acute decompensate heart failure
Discussion: Acute decompensate heart failureDiscussion: Acute decompensate heart
failureBased on the patient condition of acute decompensate heart failure, the nursing
interventions for include having the patient have supplemental oxygen and continuous
positive airway pressure (CPAP) related to the patients’ health history of sleep apnea and
has been a lifelong smoker. The patient will need breathing treatments as needed and
continuous pulse oximeter monitoring. Moreover, Mrs. J will need a chest x-ray,
electrocardiography, and follow lab tests from CBC, CMP with focus towards BNP with
normal levels to be < 100 pg/ml with regards to patients Atrial fibrillation and possible
rapid ventricular rate (Held, 2009; Ellis, 2017). Management of the condition involves four
main hemodynamic drug modalities which include beta-blockers, vasodilators, diuretics,
and ACE inhibitors. Likewise, for HF patients they may receive medications such as IV
nitroglycerin and in need of cardiac monitoring and if the condition escalates may need to
be transfer to a critical care setting. Moreover, the patient should be on restrict fluid and
low sodium diet and close monitoring of I&O, foley measurements and
electrolyte.Furosemide (Lasix) is a loop diuretic to control the symptoms of heart failure.
Primarily in conjunction with a low sodium diet, it is the first line of therapy for HF patients
and particular with this ADHF patient which “because of greater and more consistent
bioavailability of the drug. Diuretic dosing should be individualized, although common
initial doses of loop diuretic agents in patients with normal renal function include
furosemide (40 mg, intravenously)” (Joseph et al., 2009). Enalapril (Vasotect) is a ACE-
inhibitor are often considered another medication to implement as a initial therapies to be
implemented regarding heart failure by decreasing blood pressure, aldosterone secretion,
sodium, and fluid loss (Joseph et al., 2009). Metoprolol (Lopressor) decrease myocardial
oxygen demand, in doing so by improving the patients activity tolerance as well as
improving the ejection fraction. It does so by reduction of the hearts excitability, reducing
the cardiac workload through decreasing renin section and thus the blood pressure (Joseph
et al., 2009). IV Morphine Sulphate decreases preload and afterload which in turn lowers
cardiac workload. It is important to monitor VS, with caution of use related to respiratory
depression and possible dependence. Monitoring I&O and encouraging breathing exercises
(Joseph et al., 2009). Discussion: Acute decompensate heart failureADHF patients have sign
and symptoms of which include “hypotension, worsening renal function, or altered mental
status should be considered high risk and hospitalized, dyspnea, tachypnea, or hypoxemia
(again, oxygen saturation of <90%) at rest,” and can include “hemodynamically significant

2. arrhythmia, including atrial fibrillation with rapid ventricular response, warrant hospital
admission—as does any patient who presents with evidence of an acute coronary
syndrome” (Joseph et al., 2009).According to the American Heart Association is involve
coronary artery disease, hypertension, heart disease like myocarditis/cardiomyopathy, and
abnormal heart rhythm (arrhythmia or dysrhythmia) (American Heart Association, 2017).
When it comes to coronary artery disease – cholesterol build up (atherosclerosis) that’s
reducing blood flow and oxygen to heart which can lead to the develop of HF. Smoking
cessation, low sodium diet and reduction of cholesterol based foods, and increase
activity. Uncontrolled hypertension is another problem through which can develop through
the blood vessel’s increasing cardiac workload with the vessels weakening overtime.
Following prescribed BP medications with regards to alongside reduction in unhealthy diet,
increase in physical activity, stress, and decrease in alcohol consumption are steps to
follow. Conditions of cardiomyopathy will need close monitoring as it may not be apparent.
However, treatment include that of healthy diet, physical therapy, healthy weight
management, reduction in stress, and compliance with BP medications such as ACE, ARB,
beta blockers, and calcium channel blockers (American Heart Association, 2017). Abnormal
heart rhythms such as arrhythmia especially with patients that have Afib are managed
through the following, “reduce high blood pressure, control cholesterol levels, lose excess
weight, eat a heart-healthy diet, avoid tobacco smoke, and enjoy regular physical activity”
(American Heart Association).As nurses, accurate listing of the drugs and following the 8
right of medication administration provides a cohesive list that provides the nurse a
comprehensive understanding and check on all medications to be given. Polypharmacy is a
major issue and as such includes patient education of when to take them as a means of
medication compliance. This also follows patients bringing in unverified medication that is
old or usages of alternative herbal therapies that may have contraindications. Patient needs
to know that such medications may have severe adverse to medications she is taken whilst
being hospitalized. Lastly, patients should understand that the full dosage must be taken as
taking partial dosages reduce patient outcomes as the full treatment is not being
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