Cause of the elevated blood pressure, edema, and rhonchi

 

Question 1

Based on the information presented by the patient’s daughter, what is the most likely cause of the elevated blood pressure, edema, and rhonchi?

The most likely cause of the elevated blood pressure, edema, and rhonchi in this patient, given her diagnosis of congestive heart failure (CHF), is fluid retention due to inadequate management of her condition. The patient’s refusal to take prescribed medications, opting instead for herbal remedies, might contribute to her symptoms. Diuretics are critical in CHF management as they help reduce fluid overload, and without them, the patient may experience increased blood volume, leading to elevated blood pressure and peripheral edema. The presence of rhonchi suggests that there could also be fluid accumulation in the lungs, consistent with CHF exacerbation.

Question 2

What interventions should the nurse incorporate into the plan of care for this patient?

1. Medication Management: Educate the patient and her daughter about the importance of taking prescribed medications, particularly diuretics and beta-blockers. Discuss the potential risks of not adhering to the medication regimen.

2. Monitor Vital Signs: Regularly monitor blood pressure, heart rate, respiratory rate, and oxygen saturation to assess the patient’s response to treatment and any changes in her condition.

3. Assess Fluid Status: Monitor the patient’s weight daily to track fluid retention and assess for signs of worsening edema or congestive heart failure.

4. Dietary Recommendations: Encourage a low-sodium diet to help manage blood pressure and fluid retention. Provide information on appropriate food choices if language barriers allow.

5. Respiratory Care: Encourage deep breathing exercises and coughing techniques to help clear lung congestion. Assess lung sounds regularly.

6. Education on Herbal Remedies: Discuss the potential interactions and side effects of herbal remedies with prescribed medications to ensure safety and effectiveness.

7. Follow-Up Appointments: Schedule follow-up visits to monitor her condition closely, adjusting her care plan as needed based on her progress.

Question 3

What steps does the nurse need to take to become culturally competent?

1. Cultural Awareness: The nurse should engage in self-reflection to understand their own cultural beliefs and biases. This awareness is crucial for providing culturally sensitive care.

2. Education and Training: Attend workshops or training sessions on cultural competence and specific cultural practices related to the Vietnamese community.

3. Language Proficiency: Utilize professional interpreters when necessary, rather than relying solely on family members who may not accurately convey medical terminology.

4. Understanding Health Beliefs: Research and learn about traditional health beliefs and practices within the Vietnamese culture to better understand the patient’s preferences for herbal remedies over conventional medications.

5. Build Relationships: Foster trust and rapport with patients by showing respect for their cultural backgrounds and healthcare beliefs.

Question 4

What interventions can the nurse include to provide care that reflects an acceptance of the patient’s health and illness beliefs and practices?

1. Incorporate Herbal Remedies: Discuss with the patient and her daughter how certain herbal remedies may be used safely alongside prescribed medications. Provide information on which herbs may interact negatively with her medications.

2. Respect Cultural Practices: Encourage the daughter to share any cultural practices that are important to their family regarding health management, allowing them to express their beliefs openly.

3. Collaborative Care Approach: Involve the patient and her daughter in decision-making about care plans, making sure they feel heard and respected in their choices regarding treatment options.

4. Provide Education in Cultural Context: Use culturally relevant examples and language that resonate with the patient’s beliefs when educating her about CHF management and medication adherence.

5. Support Family Involvement: Recognize the role of family in healthcare decisions in many cultures, including Vietnamese culture, by including her daughter actively in discussions about care and treatment plans.

By integrating these approaches, the nurse can provide holistic care that respects the patient’s cultural identity while effectively managing her medical condition.