Question

Interactive Activity: Read the case study below and write a rationale for each of the nursing interventions listed:

Case Study	Nursing Interventions	Rationale
Ms. M was admitted with heart failure. The nursing diagnosis of “fluid volume excess r/t noncompliance to dietary Na+ restriction” is listed in her NCP. Digoxin 0.25 mg qAM PO, furosemide 40 mg qAM PO, and K-dur 10 mEq PO TID are her medications.	Weigh daily
	Monitor I & O
	Take apical pulse
	Assess skin
	Assess lungs
	✓ Neck veins

Answer 1

The nursing intervention given here is weight daily

The rationale is , weight is important parameter in cardiovascular disease patients as it may leads to artherosclerosis or arteriosclerosis due to high cholesterol level in body . The cardiovascular system failure patients also have impaired renal function so the case of hypertension is also seen in these patients.

High sodium intake may causes excess fluid to accumulate which apply pressure on arteries wall which cause rupture leads to internal bleeding .thus high sodium and cholesterol is avoided in these patients.

Regular monitoring of weight help in management of these patients