Mai Nguyen, Nam's 76 year old mother, has been complaining she feels tired all the time;

Mai Nguyen, Nam's 76 year old mother, has been complaining she feels tired all the time; she just can't do what she normally does.  She describes having a hard time catching her breath as she walks up stairs and goes about her day.  Nam has noticed that his mother's ankles are more swollen than he has ever seen them.  So he schedules an appointment for his mother at the family clinic where you are the nurse.  Mrs. Nguyen appears pale and not her usual energetic self.  Nam tells you that his mom is ""not right"" and seems to be confused about things at home, which is not like her.  She has a history of chronic congestive heart failure.

You decide to include a nursing diagnosis of Acute Confusion in Mrs. Nguyen's plan of care.

What symptoms does she have that support this nursing diagnosis?

What physiological changes are causing these symptoms?

In addition to the meds ordered, what additional therapies do you anticipate the physician will prescribe?

Mrs. Nguyen asks you, ""What can I do to make sure I never get this sick again?  How would you answer this question?"

1. Symptoms Supporting the Nursing Diagnosis of Acute Confusion:Symptoms Supporting the Nursing Diagnosis of Acute Confusion:

 Mrs. Nguyen is confused judging from Nam’s words whereby he says that things he tells her are confusing to his mother.

 She also has fatigue and shortness of breath (dyspnea) complaints which are not characteristic in her case.

 Confusion is common in older people and it’s made worse if the patient has a pale appearance and swollen ankles (edema) which could mean the patient’s condition has worsened.

 2. Physiological Changes Causing These Symptoms:Physiological Changes Causing These Symptoms:

 Mr. Nguyen has the medical care history of chronic congestive heart failure (CHF). Moreover, in CHF the strength with which the heart is pumping blood is diminished and the cardiac output is subsequently decreased. This leads to decreased blood supply of oxygen to the tissues and organs of the body such as the brain leading to confusion (cerebral hypoxia).

 CHF results in oedema in the peripheries and specifically ankles, brevit up, and fatigability. It also leads to edema that adds pressure on the heart and even decreases its pumping method.

 These symptoms of fatigue and dyspnea are consequent of reduced levels of blood flow and which make it very hard for Mrs. Nguyen to perform activities which are basic thus worsening her confusion.

 3. Additional Therapies the Physician May Prescribe:Additional Therapies the Physician May Prescribe:

 Diuretics: To aid in elimination of excess fluid in the body to decrease on oedema and lessen the load on the heart.

 Oxygen therapy: To increase the level of oxygen in the blood and, therefore, avoid hypoxemia.

 ACE inhibitors or beta-blockers: In order to enhance heart function by lowering the pressure on blood vessels and also the load on heart.

 Dietary counseling: In order to regulate salt consumption and the levels of fluid in your body, since such foods are normally high in salt content.

 Physical activity regimen: Gentle exercises that ensure that she builds her stamina as a patient with the condition without getting worse.

 4. How to Answer Mrs. Nguyen’s Question About Preventing Severe Illness in the Future:How to Answer Mrs. Nguyen’s Question About Preventing Severe Illness in the Future:

 Needless to say, it is advisable not to get this sick again and this requires you to manage your heart failure well. Some key steps include:

 Taking your medications as prescribed: It is always important to take your heart medications as prescribed as this will help manage your symptoms, and any progress in your heart diseases.

 Monitoring your weight daily: Weight gain that happens quickly might mean the buildup of fluid and one should seek medical attention about this.

 Following a low-sodium diet: Avoiding intake of salty foods, and minimize your salt intake, to avoid the problem of fluids buildup and also to give your heart a rest.

 Staying active within your limits: Strenuous and intense exercises will exert pressure on the entire body while walking exercises help to improve the condition of the heart without necessarily exerting more effort.

 Attending regular check-ups: They let your doctor monitor the health status concerning with one’s treatment and can easily detect those that are worsening.