Care Of The Patient With Spinal Cord Injury Nursing Essay

Published: Last Edited:

This essay has been submitted by a student. This is not an example of the work written by our professional essay writers.

I studied about heart failure and give nursing care to the patient with heart failure. Now I can handle a patient by using this knowledge as a reference to broaden their knowledge the disease. This is also an opportunity for me to explore what has been lean in theory and apply it on actual patient.

After the completion of this case study I got better understanding of Pathophysiology, Etiology of the Heart failure. I could expand the knowledge of the disease and how this aid disease disrupts the normal functioning of the body.

Aims and objectives

To obtain necessary information regarding the patient and his condition.

To assess the patient overall health status and identify his health care needs though analysis of all the data gathered.

To assist patient throughout relationship and discharge.

To enhance the knowledge and skills through this care study and nature of the disease it's signs and its pathophysiology its diagnosis and treatment.

Colombo North Teaching hospital-Ragama

Tuesday, September 25 ,2012

At 8.00am

General information of the patient

[A] .Assessment

[A-1] General patient information

Name :- Mrs. Patrecia Fernando

Age :- 61 years

Address :-No 24, Delathura,Ja-Ela.

Sex :- Female

Civil Status :- Married

Religion :- Buddhist

Nationality :- Sri Lankan

BHT :- 99870

Ward no :- 22

Bed no :- 29

Date & Time of Admission :- 2012-09-25

Blood group :-A possitive

[A-2] History

[a] Social history

2.1 Education Level :-up to Grade 8

2.2 Occupation :-Tailor

2.2 Monthly income :-Rs.20,000

2.3 Number of family members:- seven

2.4 Family history:- She lives with her husband , daugther and her grand children. Her husband is 67 years old and his name is Mr. Jayantha who is a driver. She has 30 years old daughter

[A-3] Living environment

3.1 House type :-Permanent house

3.2 Ventilation :-Good ventilation

3.3 Water supply :-Tap line system

3.4 Land size :-10 purch

[A-4] Cultural data

4.1 Religion :-Buddhist

4.2 Nationality :-Sri Lankan

[A-5] Life style

5.1 Dietary habits :-Non vegetarian, She like oily foods and sweets

5.2 Sleep :-No any sleeping disorders

5.3Eliminaton :-Constipation ,Polyuria

[A-6]Health history

6.1 Current illness :- On admission she complained about shortness of breathing and difficulty in breathing .She had chest pain not to radial to ulnar and sweating. She had a wound on left side big toe with pus discharge.

6.2 Past medical history:- Diabetes Mellitus,Hypertention,Ischemic heart disease

6.3Past surgical history:-Nil

6.4Past gyancological history :- Menapose

6.3 Allergic history :-Pineapple

[A-7]Systemic Assessment

7.1Weight:- 58Kg

7.2 Hight :-72cm

On admission

7.4 Temperature:- 37'c

7.5 Pulse:-118 min

7.6 Respiration:-20min

7.7 Blood Pressure:-190/100mmHg

[A-8] physical Examination Finding

8.1 head to toe observation

Face :-Worried mood

Hair & Scalp :-Gray color oily hair, no dandruff

Eyes :-Reaction to light and accommodation, no any vision problem

Ears :-Hear well, no any discharge from ears

Nose :-No any secretion, difficulty in breathing,

Mouth :-Bad smell,

Teeth :-Dental caries present

Tongue :-No any ulcers

Throat :-No any inflammation

Speech :-Normal

Neck :-No any enlargement of lymph nodes

Chest :-Crepitations

Abdomen :-No any enlargement

Hands :-Pale and cold

Fingers & nails :-Pale and cold

Legs :-wound on left side big toe with pus discharge, numbness of feet, cold lower limbs

Skin :-Pale color clammy skin,

[A-8] Investigation




Normal range




Blood uria


[B] Diagnosis

[B-1] Introduction of disease condition

Heart failure (HF), often called congestive heart failure (CHF) or congestive cardiac failure (CCF), is an inability of the heart to provide sufficient pump action to distribute blood flow to meet the needs of the body.Heart failure can cause a number of symptoms including shortness of breath leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests. Treatment commonly consists of lifestyle measures such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes, and medications. Sometimes it is treated with implanted devices (pacemakers or ventricular assist devices) and occasionally a heart transplant.

Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease hypertension, valvular heart disease, and cardiomyopathy. The term heart failure is sometimes incorrectly used for other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure.

Heart failure is a common, costly, disabling, and potentially deadly condition.] In developed countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 6-10%

[B-2] Etiology

What would you like to print?

Print this section

Print the entire contents of

 Most patients who present with significant heart failure do so because of an inability to provide adequate cardiac output in that setting. This is often a combination of the causes listed below in the setting of an abnormal myocardium. The list of causes responsible for presentation of a patient with heart failure exacerbation is very long, and searching for the proximate cause to optimize therapeutic interventions is important.

From a clinical standpoint, classifying the causes of heart failure into the following 4 broad categories is useful:

Underlying causes: Underlying causes of heart failure include structural abnormalities (congenital or acquired) that affect the peripheral and coronary arterial circulation, pericardium, myocardium, or cardiac valves, thus leading to increased hemodynamic burden or myocardial or coronary insufficiency

Fundamental causes: Fundamental causes include the biochemical and physiologic mechanisms, through which either an increased hemodynamic burden or a reduction in oxygen delivery to the myocardium results in impairment of myocardial contraction

Precipitating causes: Overt heart failure may be precipitated by progression of the underlying heart disease (eg, further narrowing of a stenotic aortic valve or mitral valve) or various conditions (fever, anemia, infection) or medications (chemotherapy, NSAIDs) that alter the homeostasis of heart failure patients

Genetics of cardiomyopathy: Dilated, arrhythmic right ventricular and restrictive cardiomyopathies are known genetic causes of heart failure.

Underlying causes

Specific underlying factors cause various forms of heart failure, such as systolic heart failure (most commonly, left ventricular systolic dysfunction), heart failure with preserved LVEF, acute heart failure, high-output heart failure, and right heart failure.

Underlying causes of systolic heart failure include the following:

Coronary artery disease

Diabetes mellitus


Valvular heart disease (stenosis or regurgitant lesions)

Arrhythmia (supraventricular or ventricular)

Infections and inflammation (myocarditis)

Peripartum cardiomyopathy

Congenital heart disease

Drugs (either recreational, such as alcohol and cocaine, or therapeutic drugs with cardiac side effects, such as doxorubicin)

Idiopathic cardiomyopathy

Rare conditions (endocrine abnormalities, rheumatologic disease, neuromuscular conditions)

Underlying causes of diastolic heart failure include the following:

Coronary artery disease

Diabetes mellitus


Valvular heart disease (aortic stenosis)

Hypertrophic cardiomyopathy

Restrictive cardiomyopathy (amyloidosis, sarcoidosis)

Constrictive pericarditis

Underlying causes of acute heart failure include the following:

Acute valvular (mitral or aortic) regurgitation

Myocardial infarction



Drugs (eg, cocaine, calcium channel blockers, or beta-blocker overdose)


Underlying causes of high-output heart failure include the following:


Systemic arteriovenous fistulas


Beriberi heart disease

Paget disease of bone

Albright syndrome (fibrous dysplasia)

Multiple myeloma



Polycythemia vera

Underlying causes of right heart failure include the following:

Left ventricular failure

Coronary artery disease (ischemia)

Pulmonary hypertension

Pulmonary valve stenosis

Pulmonary embolism

Chronic pulmonary disease

Neuromuscular disease


HF is a progressive heterogenous condition caused by combinations of hemodynamic and neurohormonal abnorma-lities. These abnormalities are typically dynamic, leading to wide fluctuations over time in cardiac function, volume status, and physical functioning in individual patients. HF signs and symptoms initially occur when the heart is unable to produce sufficient cardiac output to perfuse body tissues and meet metabolic demands. Initially beneficial compensatory neurohormonal and parahormonal mechanisms can eventually lead to progression and perpetuation of the HF syndrome.

Figure shows the pathophysiology of heart failure. The common risk factors or conditions that lead to hemodynamic abnormalities at the cardiac level include myocardial ischemia and infarction, hypertension, aging, obesity, diabetes, valvular heart disease, congenital heart defects, and alcoholism. Additional risk factors for coronary artery disease (hyperlipidemia, smoking, homocysteine) because they lead to eventual myocardial injury are also indirect risk factors for heart failure. Most patients have multiple risk factors for HF.

These risk factors either through myocardial injury or persistent alteration of cardiac hemodynamic forces lead to impaired LV function. In a patient with signs and symptoms of HF, left ventricular dysfunction can be present during systole, diastole, or both. In patients with systolic dysfunction the reduction in the transmural forces across the left ventricle and possibly reduced cardiac output detected by the kidneys lead to activation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS). Heightened activity of these two neurohormonal systems leads to further myocardial toxicity, peripheral vasoconstriction, and renal salt and water retention. The activation of these systems leads to further worsening of LV function and progressive remodeling of the heart . The principal manifestation of cardiac remodeling is a change in the shape of the left ventricle such that the chamber dilates, hypertrophies, and becomes more spherical. Initial dilitation of the ventricle creates a mechanical advantage for maintaining stroke volume and cardiac output. Eventually, changes in chamber size increase the mechanical stress on the walls of the heart, increase myocardial oxygen demand, and further reduce ventricular performance. If these processes proceed unimpeded, the heart continues to dilate to the "big baggy heart" seen in end-stage systolic dysfunction HF.

Approximately 40% of primary care HF patients have normal LV systolic function. The most common underlying abnormality in HF patients with normal systolic function is LV diastolic dysfunction. Reduced diastolic capacity and impaired ventricular relaxation causes a decrease in ventricular filling rate and volume during diastole and elevated end-diastolic pressure. Persistent activation of neurohormonal mechanisms also plays a role in fluid retention and HF signs and symptoms for patients with isolated diastolic dysfunction. Common causes of HF with normal systolic function include Inaccurate diagnosis of HF (e.g., chronic obstructive pulmonary disease [COPD]) Inaccurate measurement of LV ejection fraction (LVEF) LV systolic function overestimated by LVEF (e.g., mitral regurgitation) Episodic LV systolic dysfunction, normal at the time of evaluation (severe hypertension, ischemia, tachycardia, infection, volume overload, spontaneous variability of EF)

[C] Review of anatomy related organ of the disease

Anatomy of the Heart

The heart weighs between 7 and 15 ounces (200 to 425 grams) and is a little larger than the size of your fist. By the end of a long life, a person's heart may have beat (expanded and contracted) more than 3.5 billion times. In fact, each day, the average heart beats 100,000 times, pumping about 2,000 gallons (7,571 liters) of blood.

Anatomy of the Heart

Your heart is located between your lungs in the middle of your chest, behind and slightly to the left of your breastbone (sternum). A double-layered membrane called the pericardium surrounds your heart like a sac. The outer layer of the pericardium surrounds the roots of your heart's major blood vessels and is attached by ligaments to your spinal column, diaphragm, and other parts of your body. The inner layer of the pericardium is attached to the heart muscle. A coating of fluid separates the two layers of membrane, letting the heart move as it beats, yet still be attached to your body.

Your heart has 4 chambers. The upper chambers are called the left and right atria, and the lower chambers are called the left and right ventricles. A wall of muscle called the septum separates the left and right atria and the left and right ventricles. The left ventricle is the largest and strongest chamber in your heart. The left ventricle's chamber walls are only about a half-inch thick, but they have enough force to push blood through the aortic valve and into your body.

[D] contributing factors of heart failure

High blood pressure. Your heart works harder than it has to if your blood pressure is high.

Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.

Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.

Irregular heartbeats. These abnormal rhythms can create extra work for your heart, weakening the heart muscle.

Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.

Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure. Don't stop taking these medications on your own, though. If you're taking them, discuss with your doctor whether you need to make any changes.

Sleep apnea. The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.

Congenital heart defects. Some people who develop heart failure were born with structural heart defects.

Viruses. A viral infection may have damaged your heart muscle.

Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure.

Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention.

[E] Clinical manifestation of acute heart failure

Symptoms similar to those of chronic heart failure, but more severe and start or worsen suddenly

Sudden fluid buildup

Rapid or irregular heartbeat (palpitations)

Sudden, severe shortness of breath and coughing up pink, foamy mucus

Chest pain, if your heart failure is caused by a heart attack

Fatigue and weakness

Shortness of breath (dyspnea) when you exert yourself or when you lie down

Reduced ability to exercise

Persistent cough or wheezing with white or pink blood-tinged phlegm

Swelling in your abdomen, legs, ankles and feet

Difficulty concentrating or decreased alertness

[F] Clinical manifestation of the patient

Mrs . Patrica had ,

Shortness of breathing

Chest pain



Fatigue and weakness

Swelling of legs

[G] Diagnostic Evaluation

The diagnosis of AHF is based on the symptoms and clinical findings, supported by appropriate investigations such as ECG, chest X-ray, biomarkers, and Doppler-echocardiography. The patient should be classified according to previously described criteria for systolic and/or diastolic dysfunction , and by the characteristics of forward or backward left or right heart failure.

Clinical evaluation

Systematic clinical assessment of the peripheral circulation, venous filling, and peripheral temperature are important.

Right ventricular (RV) filling in decompensated heart failure may usually be evaluated from the central jugular venous pressure. When the internal jugular veins are impractical for evaluation the external jugular veins can be used. Caution is necessary in the interpretation of high measured central venous pressure (CVP) in AHF, as this may be a reflection of decreased venous compliance together with decreased RV compliance even in the presence of low RV filling.

Left sided filling pressure is assessed by chest auscultation, with the presence of wet rales in the lung fields usually indicating raised pressure. The confirmation, classification of severity, and clinical follow-up of pulmonary congestion and pleural effusions should be done using the chest X-ray.

Electrocardiogram (ECG)

A normal ECG is uncommon in acute heart failure. The ECG is able to identify the rhythm, and may help determine the aetiology of AHF and assess the loading conditions of the heart. It is essential in the assessment of acute coronary syndromes. The ECG may also indicate acute right or left ventricular or atrial strain, perimyocarditis and pre-existing conditions such as left and right ventricular hypertrophy or dilated cardiomyopathy. Cardiac arrhythmia should be assessed in the 12-lead ECG as well as in continuous ECG monitoring.

Chest X-ray and imaging techniques

Chest X-ray and other imaging should be performed early for all patients with AHF to evaluate pre-existing chest or cardiac conditions (cardiac size and shape) and to assess pulmonary congestion. It is used both for confirmation of the diagnosis, and for follow-up of improvement or unsatisfactory response to therapy. Chest X-ray allows the differential diagnosis of left heart failure from inflammatory or infectious lung diseases. Chest CT scan with or without contrast angiography and scintigraphy may be used to clarify the pulmonary pathology and diagnose major pulmonary embolism. CT scan or transesophageal echocardiography should be used in cases of suspicion of aortic dissection.

Laboratory tests

Blood tests routinely performed include electrolytes (sodium, potassium), measures of renal function, liver function tests, thyroid function tests, a complete blood count, and often C-reactive protein if infection is suspected. An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure. Additionally, BNP can be used to differentiate between causes of dyspnea due to heart failure from other causes of dyspnea. If myocardial infarction is suspected, various cardiac markers may be used

[H] Management/Treatment/Theraphy

[H-1] Pharmacologycal management

Oral Asprin 75mg nocte

Oral Clopidojal 75mg nocte

Oral Atrovastain 20mg mane

Oral Carvedilol 3.125 mg mane

Oral Spirinolacton 25mg mane

Oral ISMN 30mg bd

Oral Clarythromycine 500mg tds

IV Frusomide 60 mg bd

IV Co-amoxicalv 1.2g tds

[H-2] Non pharmacological management

-QHT Chart maintained.

-Sugar chart

-Prop up the patient

.Objectives of Nursing Care Plan

Short term objectives Long term objectives

To reduce difficulty in breathing To prevent complications

To maintain personal hygiene To give health education

To reduce anxiety To mobilize the patient

To improve knowledge regarding his disease condition

Care plan - Day 01

Date &



Nursing diagnosis

Planning(with Goal)




Summary of Assessment & Management in non-contact time duration

Non-contact time:-

Assessment & Management :-

-Observe patient closely.

-Drugs given according to the BHT.

-RBS check and charted

Approval for the study

…………………………………………………………. ………………………………………..

Nursing Manager/ Nurse in charge of ward Nursing Tutor

Care plan - Day 02

Date &


Nursing Assessment

Nursing Diagnosis






At 7.00 A.M

-Today is the third day of his hospitalization.

-patient looks ill.

-He is in strict bed rest.

-Poor oral hygiene.

-poor personal hygiene.

-Dressing applied to his chin and left knee joint.

-Oxygen given via face mask.

-Patient was connected to the pluseoxymeter.


PR-100 min

RR - 20 min

SpO - 94%

-Cervical collar applied.

-Cannula has been placedin both hands.

-Normal saline 450 ml IV drip continued.

-Urine catheter has been placed.

-Urine passed well.

-Today patient

Complained difficult in breathing.

-Pain on shoulder joint

-He complained that he feel heaviness of head and head ache.

-Today bowel not opened.

-Patient is in Nil orally.

-IV fluid continued.

-Today CT Scan done.

-ECG taken.

-Observation chart maintained.

-QHT chart, In put out put chart maintained.

1.Ineffective breathing pattern related to disease condition.

2. Pain related to the fracture of shoulder joint.

2. Heaviness of head and head ache related to the hospitalization

3.Self care deficit related to the fracture of vertebra collum.

4.Risk for complication related to the immobilization

To reduce difficulty in breathing

-Provide good ventilation.

-Establish and maintain air way patency.

-maintained observation chart.

-Give oxygen therapy.

To reduce pain

-Provide comfortable position.

-Apply hot formentation.

-Apply comfortable devices.

-Administer pain medication as requested and prescribed.

-Log roll when needed.

To reduce heaviness of head and head ache

-Talk with the patient in kind manner.

-Apply cold compress.

-Prepare clam and quite environment.

To improve personal hygiene

-Give special mouth care given.

-Give bed bath.

-Change the bed linen.

To prevent complication.

-Identify areas at risk prominences depending on position assumed.

-Inspect skin after each position change.

-Inspect for open or ulcerated areas and localized oedema.

-Administer lotion to bony and reddened areas.

-Provided good ventilation.

-Oxygen given via face mask.

-Observation chart maintained.

-Changed the position using log roll method.

-Applied hot formantation.

-Drugs given according to the BHT.

-Talked with him in kind manner.

-Applied cold compress.

-Mouth care given with NaCl and NaHCO

-Bed bath given with luke worm water.

-Change the bed linen.

-Back massage given with body lotion.

-Position changed every 2 hourly.

-Apply water cushion

SpO -99%

Blood pressure - 130/80 mmHg

Pulse rate - 90min

Respiration rate -20min

Observed 20min

No any allergic reaction.

Pain reduced pain

Reduced his head ache.

Dry mouth seen.

No any bed sore.

Patient said that he feels comfortable.

No any bed sores.

Patient said that he feels comfortable

Summary of Assessment & Management in non-contact time duration

Non-contact time :-

Assessment & Management:-

-Continued IV fluid

-Drugs given according to the BHT

-RBS check and charted

-ECG taken

Approval for the study

………………………………………………….. ……………………………………

Nursing Manager/ Nurse in charge of the ward Nursing Tutor

Care plan - Day 03

Date &



Nursing Diagnosis





-Today is fourth day of his hospitalization.

-Patient's looks ill.

-He is still in bed rest.

-Poor oral and personal hygiene.

-Oxygen given via face mask.

Blood pressure- 130/70mmHg

-SpO - 99%

Pulse rate - 100min

Respiration rate-


-Today bowel not opened and passed urine.

-Today start oral fluid.

-Patient complained about mild pain on shoulder joint.

-Patient complained about he has sleeplessness at night after this condition.

-He said he had neck pain, and heaviness of head.

-Cervical collar applied.

-Thoraco lumbar brace has placed.

-Physiotherapy given and ECG taken.

1.Neck pain related to the cervical collar apply

2.Alteration in constipation related to decreased activity level.

4.Risk for social isolation related to the prolonged hospitalization.

To reduce neck pain

-Loose cervical collar.

-Apply some local application.

-Apply cold compress.

-Change the position using log roll method.

To maintain regular elimination

-Assess for signs of constipation.

-Maintained appropriate diet.

-Establish regular routine, same hour of day, usually after the breakfast.

-Instruct patient on need for good hydration.

-Force fluids as necessary unless contraindicated.

To reduce social isolation.

-Assess for signs and symptoms suggestive of social isolation.

-Promote privacy for patients and visitors.

-Encourage verbalization regarding social contacts.

-Loosed the cervical collar.

-Applied cold compress.

-Changed the position 2 hourly.

-Give high fiber diet.

-Established regular time.

-Instructed to the patient about good hydration.

-Assessed for signs and symptoms suggestive of social isolation.

-Promoted privacy

Reduced his neck pain.

Patient said that pass small amount of stool.

No any signs and symptoms of social isolation.

Summary of Assessment & Management in non-contact time duration

Non-contact time :-

Assessment & management :-

-Continued IV fluid

-Drugs given according to the BHT

-RBS check and charted

No chest pain no difficulty in breathing

-According to these conditions the physician decided to discharge the patient

Approval for the study

………………………………………………………… ………………………………………….

Nursing Manager/Nurse in charge of the ward Nursing Tutor

Drug Study



Name of the Drug





Side effects

Nursing Responsibilities


















Co- amoxicalv




75 mg
























Exhibitsantipyretic, anti-inflammatory andanalgesic effects. The antipyreticeffect is due to anaction on thehypothalamus,resulting in heatloss by vasodilation of peripheral blood vessels. Anti-inflammatory effects are mediated by adecrease inprostaglandinsynthesis. It alsodecreases

The anti-clotting action of the medication clopidogrel (Plavix) can be compromised by common drugs for the treatment of heartburn and ulcers resulting in a roughly 50% increase in the combined risk of hospitalization for heart attack, stroke and other serious cardiovascular illnesses

Atorvastatin reduces levels of "bad" cholesterol and triglycerides in the blood, while increasing levels of "good" cholesterol

Atorvastatin is used to treat high cholesterol, and to lower the risk of stroke, heart attack.

Carvedilol is used to treat heart failure (condition in which the heart cannot pump enough blood to all parts of the body) and high blood pressure. It also is used to treat people whose hearts cannot pump blood well as a result of a heart attack. Carvedilol is often used in combination with other medications. Carvedilol is in a class of medications called beta-blockers.

Spironolactone is used to treat certain patients with hyperaldosteronism ; low potassium levels; and in patients with edemacaused by various conditions, including heart, liver, or kidney disease. Spironolactone is also used alone or with other medications to treat high blood pressure.

Nitrates are drugs that act directly on the smooth muscle to cause relaxation and to depress muscle tone

Inhibits protein synthesis in susceptible bacteria, causing cell death.

Loop diuretic; inhibits reabsorption of Na+ and Cl- at proximal and distal renal tubules and loop of Henle. By interfering with the chloride binding cotransport system, it cuases an increase in water, calcium, magnesium, sodium, and chloride.

The combination is bactericidal.

irritation of the stomach or bowel


nausea (feeling sick)

bloody or tarry stools, blood in your urine;

coughing up blood or vomit that looks like coffee grounds;

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

pale skin, weakness, fever, or jaundice (yellowing of the skin or eyes); or

easy bruising, unusual bleeding


Insomnia and dizziness

Chest pain and peripheral edema


Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, n









vision changes

joint pain

difficulty falling asleep or staying asleep



stomach pain or cramps

dry mouth




Headache, dizziness ,and myasthenia. (GI) N & V and incontinence. ( CV) Hypotension. (SKIN) Flushintg  pallor sweating and increased perspiration

Dizziness, headache, vertigo, somnolence, fatigue, Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, pseudomembranous colitis, Superinfections, increased PT, decreased WBC


Glucose intolerance


Urinary frequency







Side effects are uncommon and mainly of a mild and transitory nature.

Diarrhoea, indigestion, nausea, vomiting, and mucocutaneous candidiasis have been reported.

History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation

Physical: Skin color, lesions; T; eighth cranial nerve function, orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver evaluation,

Assess for symptoms of stroke, MI during treatment


Monitor liver function studies :AST, ALT, bilirubin ,creatinine if  patient is on long-term therapy


Monitor blood studies:CBC,Hgb, Hct, pro time, cholesterol if the patient is on long-term therapy; thrombocytopenia and neutropenia may occur

Atorvastatin is used in patients with homozygous familial hypercholesterolemia as an adjunct to other lipid-lowering treatments or alone only if other treatments aren't available. Atorvastatin adjunct to-not a substitute for-low-cholesterol diet.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

Spironolactone should not be taken under any circumstance by pregnant women due to the high risk of feminization of male fetuses.

Instruct patient to take medication as directed, even if feeling better. Take missed doses as soon as remembered; doses of isosorbide dinitrate should be taken at least 2 hr apart (6 hr with extended-release preparations); daily doses of isosorbide mononitrate should be taken 7 hr apart.

Culture infection before therapy.

ï‚· Do not cut or crush, and ensure that patient does not chew ER tablets.

ï‚· Monitor patient for anticipated response.

ï‚· Administer without regard to meals;

Protect CARPUJECT from light. Do not remove cartridges from package until time of use.

Do not use the injection if it is discolored or contains a precipitate

Protect CARPUJECT from light. Do not remove cartridges from package until time of use.

Do not use the injection if it is discolored or contains a precipitate

Discharge and follow up care

-On admission patient complains that,

-Difficulty in breathing.

-Pain on shoulder joint.

-Swelling of shoulder joint.

-Can notmobilizedhis right upper limb.

-On admission give knowledge related to his disease condition.

-Maintained observation chart, Temperature chart, Fluid balance chart.

-Applied cervical collar and Thoraco lumbar brace.

-Given health education to the patient about prevent complication.

-Advised to do exercise to his lower limbs.

-Explained about loss of mobility and altered nutrition place patient at risk of skin break down.

-Explained about importance of maintain appropriate diet.

-Given health education about change his position in two hourly, using log rolling method.

-Given physiotherapy exercises.

-Advised to take adequate fluid.

-According to these conditions the physician decided to transfer to National hospital Colombo.

Discussion and Conclusion.

In finally I got wide knowledge regarding management of patient with acute heart failure and her nursing care. In these care study I studied about the pathophyciolgy , etiology anatomy of the heart, risk factors , investigation, and management of heart failure.

Heart failure (HF), often called congestive heart failure (CHF) or congestive cardiac failure (CCF), occurs when the heart is unable to provide sufficient pump action to distribute blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests. Treatment commonly consists of lifestyle measures such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes, and medications. Sometimes it is treated with implanted devices (pacemakers or ventricular assist devices) and occasionally a heart transplant.


Lippincott manual of Nursing practice,

Williams & Wilkins,

9th edition published by Japee brothers

Medical surgical Nursing,

BT Basavanthaappa

2ed edition published by Japee brothers

From Wikipedia, the free encyclopedia