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This paper will demonstrate the author’s ability to prescribe safely from the Nurse Prescribing Formulary (NPF 2009-2011). A prescribing situation undertaken by myself while supervised by my mentor will be discussed. The patients name, address, date of birth and GP details have been changed to ensure patient confidentiality in accordance with the Nursing and Midwifery Council (NMC)(2004). The patient therefore will be referred to under the pseudonym Prince Charming.

You don 't come cross anaphylactic shock often, but you still have to be aware. Other severe adverse reactions that could include a fever and skin blistering; these usually occur within an hour of the medications being administered. Sometimes adverse reactions can develop over a few weeks, they may cause damage to the kidneys or liver. If adverse reactions are not treated they could be fatal. When individuals experience adverse reactions to medicines my workplace policy is to inform the GP and explaining in detail the adverse reactions, the staff member will then inform the individual/ team. GP advise and guidance will then determine if the medication is to be stopped. If the reactions are so serious then an ambulance should be called my responsibility is that I have duty to continue to observe the individual and monitor their vitals, speaking to them and looking at any changes, so as to ensure that the individual is not deteriorating. All adverse reactions and following advice given, must be recorded in full in the individual’s clinical note and referenced in their daily report also MAR’s chart. 4.

Chest pain, dyspnea (especially on exertion), orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, history of cardiac problems, family history of cardiac problems, cardiac risk factors, & current medications.

other intense tests can be done to make the diagnosis much clearer such as Doppler echocardiogram, this uses sound waves to show the function of the right ventricle to measure the blood flow through the heart valves, and then calculate the systolic pulmonary artery pressure. There is also an X-ray, this is done on the chest. This can show any increase or decrease in size of the right ventricle and arteries. A simpler test such as the 6-minute walk test, this controls exercise patience level and blood oxygen saturation level during exercise. There is also a Pulmonary function test, this seeks for other lung conditions such as chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis compared to others. Also there is a 'Polysomnogram or overnight oximetry', this monitors sleep apnea (results in low oxygen levels at night). Also a right heart catheterization, this measures various heart pressures ( inside the pulmonary arteries, coming from the left side of the heart), the rate at which the heart is able to pump blood, and finds any leaks between the right and left sides of the heart.

Heart failure affects nearly 6 million Americans. It is the leading cause of hospitalization in people older than 65. Roughly 550,000 people are diagnosed with heart failure each year (Emory Healthcare, 2014). Heart failure is a pathologic state where the heart cannot pump enough blood to meet the demand of the body’s metabolic needs or when the ventricle’s ability to fill is impaired. It is not a disease, but rather a complex clinical syndrome. The symptoms of heart failure come from pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Individuals experience orthopnea,

Are there any contraindications for this drug? Hypersensitivity, cross-sensitivity with other NSAID’s such as aspirin, history of allergic reactions, asthma, advanced renal disease, hepatic dysfunctions, perioperative pain.

Check for normal breathing, taking no more than 10 seconds: Look for chest motion, listen for breath sounds, and

The potential complications if you do not stay compliant with the regimen are; low potassium which can lead to muscle cramps, weakness and fatigue, constipation, difficulty breathing, or an abnormal heart rhythm; Acute kidney failure

The diagnosis is made when an ejection fraction of less than 40% is found during an echocardiogram test. Patients with known systolic heart failure and current or prior symptoms are Stage C. Most common symptoms include, shortness of breath, fatigue and reduced ability to exercise. Stage D is patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care. Other risk factors for heart failure are some diabetes medications, sleep apnea, congenital heart defects, viruses, and irregular heartbeats. Heart Failure can be treated and managed but not cured. It is a chronic condition.

Also, physicians need the routine lab testing results as this helps them diagnose and initiate treatment plans for patients with heart failure. The lab tests that are recommended by the American Heart Association and others to evaluate for heart failure are: a complete blood count (CBC), which may indicate anemia and possibly an infection as one of the possible causes of heart failure. A basic metabolic panel (BMP) would show serum electrolytes and may help with diagnosing fluid retention or renal failure. Also, B-type natriuretic peptide levels (BNP) are up in heart failure. A twelve lead electrocardiogram (ECG or EKG), shows the electrical activity of the heart and may help reveal arrhythmias, infarctions, or even heart failure (Petersen, M., Wang, Y., Van der Laang., M. & Guzman, D.

Sensing process is the initial stage of our process. Heart problems like Chronic Heart Failure Disease affected people have 70% of possibility to cause of critical heart failure i.e. Acute Decompensated Heart Failure (ADHF). The concept of outpatient monitoring for early detection and treatment of ADHF is not new. However, the question of which parameters to monitor and what specific detection strategies should be used to prevent hospitalization has not been adequately addressed. Symptoms such as orthopnea and physical examination signs such as pulmonary rales, peripheral edema, and elevated jugular venous pressure reflect increased ventricular filling pressures and vascular congestion and are often used for the diagnosis of ADHF. However,

Therapeutic measures for a patient with congestive heart failure would be daily weights, dietary sodium restrictions, positioning in high or semi-Fowler’s position, frequent vital signs, oxygen by cannula or mask, medical devices: pacemakers, internal cardiac defibrillator, biventricular cardiac pacemaker, ventricular assist device, medications: digoxin, diuretics, inotropes, nesiritide, beta blockers, surgery: heart valve repair or replacement, coronary

A person with left sided heart failure my experience SOB and increased episodes of coughing caused by fluid buildup in the lungs. Pulmonary edema often causes a patient to cough up blood-tinged phlegm. (Cadwallader p. 1143). The PMI is displaced toward the left anterior axillary line, and there is a presence of S3 caused by ventricular filling, and/or S4 resulting from atrial contraction against a noncompliant ventricle. (Schilling-McCann p. 176). The person may have cool, pale skin resulting from peripheral vasoconstriction. Restlessness and confusion is normally due to decreased cardiac output.

Adverse reactions to this medication are migraine, speech disorders, rhinitis, sinusitis, hyperglycemia, elevated liver function, elevated serum creatinine level, pancytopenia, bronchitis, dyspnea, toxic epidermal necrolysis, anaphylaxis, elevated creatine kinase, generalized pain, and infection. Nursing considerations with this medication is to have the patient swallow the whole tablet and not to chew. Watch for aspiration while watching the patient take the medication. Educate the patient about the medication and inform them to notify a physician if bleeding

Monitoring of the vital signs should be closely monitored (pulse, blood pressure, respiration and pulse oximetry