Pre-Simulation Plan of Care
COPD
Student Name: Naylea Cabral
Date: February 6, 2023
Patient Initials: CJ
Patient Age: 68 Years Old
Admitting Diagnosis: CHF (Congestive Heart Failure)
Chief Complaint:
Patient is experiencing difficulty breathing
Past Medical History:
HTN x 10 years, Atrial Fibrillation (AF), CHF x 5 years, hyperlipidemia, and a 20-year history of smoking 1 pack of cigarettes a day.
Test & Procedures:
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CBC - A complete blood count, also known as a full blood count, is a set of medical laboratory tests that provide
information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and
platelets, the concentration of hemoglobin, and the hematocrit.
Blood Chemistry Test - A test done on a sample of blood to measure the amount of certain substances in the body. These
substances include electrolytes (such as sodium, potassium, and chloride), fats, proteins, glucose (sugar), and enzymes.
Blood chemistry tests give important information about how well a person’s kidneys, liver, and other organs are working.
An abnormal amount of a substance in the blood can be a sign of disease or side effect of treatment. Blood chemistry tests
are used to help diagnose and monitor many conditions before, during, and after treatment. Also called blood chemistry
study.
Cardiac Enzyme Test - Your heart releases cardiac enzymes when there’s heart damage or stress due to low oxygen.
Troponin and creatinine phosphokinase (CPK) levels rise after a heart attack. Elevated heart enzyme levels can also
indicate acute coronary syndrome or ischemia. Healthcare providers use enzyme marker tests (blood tests) to measure
cardiac enzymes.
Echocardiogram - An echocardiogram is an ultrasound and uses sound waves to create pictures of the heart. This common
test can show blood flow through the heart and heart valves. Your health care provider can use the pictures from the test
to find heart disease and other heart conditions.
ECG or EKG - An electrocardiogram records the electrical signals in the heart. It's a common and painless test used to
quickly detect heart problems and monitor the heart's health.
Chest X-Ray - A chest radiograph, called a chest X-ray is a projection radiograph of the chest used to diagnose conditions
affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in medicine.
Medications:
Medications
Indications
Significant Side effects
Patient’s dose, route and
frequency; Normal dose
range
Nursing responsibilities
Generic: Furosemide
Indicated to treat CJ
for edema related to
CHF.
Hypotension,
headache. Vision
problems,
hyperglycemia,
constipation, fever,
and tinnitus.
80mg IV twice a day
Assess fluid status. Monitor daily weight,
intake and output ratios, amount and
location of edema, lung sounds, skin turgor,
and mucous membranes. Notify health care
professional if thirst, dry mouth, lethargy,
weakness, hypotension, or oliguria occurs.
Trade: Lasix
Classification:
Diuretic
Normal dose - 20–40 mg,
may repeat in 1–2 hours
and ↑ by 20 mg every 1–2
hours until response is
obtained
Patient’s dose is above
normal range.
Generic: Ramipril
Trade: Altace
Classification: ACE
Inhibitor
CJ has a 10x history
of HTN.
Headache, cough,
dizziness, tiredness,
nausea, vomiting and
stomachache
5mg po daily
Normal range is 2.5mg to
20mg per day once
Patient is in normal
range.
Monitor vitals before and
administration to detect any
changes.
during
adverse
Monitor BP and pulse frequently during
initial dose adjustment and periodically
during therapy. Notify health care
professional of significant changes.
Assess patient for signs of angioedema
(swelling of face, extremities, eyes, lips,
tongue, difficulty in swallowing or
breathing); may occur at any time during
therapy. Discontinue medication and
provide supportive care.
Monitor weight and assess patient routinely
for resolution of fluid overload (peripheral
edema, rales/crackles, dyspnea, weight gain,
jugular venous distention).
Generic: Carvedilol
Trade: Coreg
Indicated to CJ to
treat heart failure and
HTN.
Classification: Beta
Blocker
Fatigue, dizziness,
memory loss,
pulmonary edema,
bradycardia, impaired
vision, hypoglycemia,
and wheezing.
3.125mg po daily
Normal dose range is
6.25mg twice daily or
3.125mg twice daily
CJ’d dose is in limits.
Generic: Amiodarone
CJ has 5x history of
atrial fibrillation.
Trade: Nexterone
Pacerone
Classification:
Antiarrhythmics
Generic: Potassium
Chloride
Trade: Klor-Con
Classification:
Electrolytes
Indicated to CJ to
prevent hypokalemia
a common
complication of CHF.
Cough, fever,
dizziness, faint,
numbness in fingers,
painful breathing,
trembling,
constipation,
headache, nausea.
200mg po daily
Nausea, vomiting,
diarrhea, and
stomachache
40 meq po daily.
Normal dose range is
800mg-1600mg po per
day
Patient’s dose is below
normal limits.
Normal dose range is 40100 meq per day
Patient is in normal
range.
Monitor the patient’s vital signs frequently
and any changes in heart rate and BP. In
addition, assess the chest and lungs for any
symptoms of pulmonary edema.
Monitor intake and output ratios and daily
weight. Assess patient routinely for evidence
of fluid overload (peripheral edema,
dyspnea, rales/crackles, fatigue, weight
gain, jugular venous distention). Patients
may experience worsening of symptoms
during initiation of therapy for heart
failure.
Monitor patient’s vital signs and ECG for
changes in HR and any arrythmias that
occurs.
Auscultate
chest
for
any
abnormalities.
Report bradycardia
arrhythmias promptly
or
increase
in
Observe patient carefully for evidence of
electrolyte excess or insufficiency. Monitor
lab values before and periodically
throughout therapy.
Generic:
Spironolactone
Trade: Aldactone
Classification:
Diuretics
Indicated to CJ to
counteract potassium
loss caused by other
diuretics. Used with
other agents to treat
edema
or
hypertension.
Drowsiness, dizziness,
headache,
lightheadedness, and
electrolyte
disturbance.
12.5mg po daily
Normal range is 25200mg daily
Patient is below normal
range.
Monitor patient’s vital signs are within
normal range. Must monitor potassium
levels and BP.
Monitor intake and output ratios and daily
weight during therapy.
Assess patient frequently for development of
hyperkalemia (fatigue, muscle weakness,
paresthesia, confusion, dyspnea, ECG
changes, cardiac arrhythmias)
Generic: Warfarin
Trade: Coumadin
Jantoven
Classification:
Anticoagulant
Indicated to CJ as
prophylaxis treatment
to prevent blood clots,
DVT and pulmonary
embolism as well as
management of atrial
fibrillation
Nausea, dermal
necrosis, increased
risk of bleeding, fever,
and cramps.
2.5mg po daily
Normal dose range is
2mg -5mg daily for about
2-4 days.
Monitor for clotting factors and any sign of
hemorrhaging. Assess for bruises, bleeding
gums, distended abdomen, bloody stools.
Patient is in normal
range.
Focused Assessments:
Cardiovascular: Patient has history of congestive heart failure for 5
years, high blood pressure for 10 years, and atrial fibrillation.
Psychosocial/ Emotional: Not Assessed
Respiratory:
Safety:
CJ is having difficulty breathing.
CJ is having difficulty breathing making him a fall risk when
ambulating.
GU: Not Applicable
Patient/Family educational needs:
Patient and family must be educated on smoking cessation and
provided with outpatient resources to aid in lifestyle change.
GI: Not Applicable
Musculoskeletal: Not Applicable
Endocrine: Not Applicable
Medical Plan of Care:
Problem 1:
CHF (Congestive Heart Failure)
Assessment:
Patient having difficulty breathing
Chest X-Ray, CBC, Blood Chemistry, Echocardiogram, EKG, and Cardiac Enzymes tests ordered by physician – pending results
Treatment/Outcomes/Medications:
Patient receiving:
 Lasix 80 mg IV twice daily.
 Altace 5 mg po daily
 Coreg 3.125mg po twice daily
 Amiodarone 200mg po daily
 K-dur 40 meq po daily
 Spironolactone 12.5mg po daily
 Coumadin 2.5 mg po daily
Nursing Plan of Care:
Assessment:
Problem:
Include your
patient’s defining
characteristics,
risk factors, Signs,
and symptoms
(List 3
Diagnoses)
NANDA 2-part
statement
(Diagnostic label
related to...)
CJ is having
difficulty breathing.
CJ has 5-year
history of CHF.
CJ has 5-year
history of atrial
fibrillation.
.
Decreased cardiac
output related to
alterations in rate,
rhythm, electrical
conduction as
evidenced by atrial
fibrillation.
Patient safety
Issues
Identify potential
complications and
explain how it is
related to the
identified nursing
diagnosis
Decreased cardiac
output may result
in insufficient
blood supply and
compromise vital
reactions leading to
organ damage.
Planned outcomes
Implementation
Rationale for
Interventions
Position the patient
upright (fowlers or
semi-fowlers) if
tolerated. Regularly
check the patient’s
position to prevent
sliding down in bed.
Elevating the head of the
bed will allow the patient
better positioning for
breathing and be able to
maintain an appropriate
oxygenation level.
Give medications as
prescribed, such as
beta blockers and
ACE inhibitors
noting effectiveness
and side effects.
Medications are prepared to
manage specific problems.
For CJ his prescriptions will
help to improve heart
function and decrease
patient’s symptoms and
cardiac workload.
Educate patient about
smoking cessation
and provide
outpatient resources
Smoking causes damage to
body’s organs and impairs
proper function.
Long term AND
short term goals.
Must be measurable
including a time
frame
Patient will
demonstrate adequate
cardiac output as
evidenced by vital
signs within
acceptable limits,
dysrhythmias
controlled, and no
symptoms of failure
by end of shift.
Patient will report
decreased episodes of
dyspnea and angina
by end of shift.
Long Term – Patient
will be able to
verbalize future selfcare activities to
improve cardiac
health such as
smoking cessation
CJ is having
difficulty breathing.
Impaired gas
exchange related
to pulmonary
congestion
secondary to CHF
as evidenced by
dyspnea.
Potential
complications from
this nursing
diagnosis include
inadequate
oxygenation,
hypoxemia, or
hypercapnia
Patient will maintain
SpO2 above 90% by
end of shift
Patient’s respiratory
pattern
will
be
effective
without
causing fatigue by
end of shift
Long Term – Patient
will stop smoking
and continue
respiratory
rehabilitation
CJ is having
difficulty breathing.
CJ has 5-year
history of CHF.
Acute pain related
to decreased
myocardial blood
flow as evidenced
by difficulty
breathing
Potential
complications from
acute pain are
worsening of
existing chronic
diseases, alterations
in HR, BP, and RR.
Acute pain will
also increase the
patient’s risk for
falls.
Patient’s pain will be
decreased by end of
shift.
The client will report
reduced episodes of
dyspnea.
Administer oxygen as
ordered to maintain
oxygen saturation
above 90%.
Position the patient
upright (fowlers or
semi-fowlers) if
tolerated. Regularly
check the patient’s
position to prevent
sliding down in bed.
Educate patient about
smoking cessation
and provide
outpatient resources
Administer
prescribed
medications such as
vasodilators and pain
medication as
ordered.
Provide comfort
measures.
Long Term:
Patient will be able to
ambulate and
perform ADLs
without pain.
Supplemental oxygen
improves gas exchange and
oxygen saturation. The
patient may need a nasal
cannula or other devices
such as a venturi mask
This position promotes
better lung expansion and
improved air exchange.
Smoking causes damage to
body’s organs and impairs
proper function.
The vasodilator
nitroglycerin enhances
blood flow to the
myocardium. It reduces the
amount of blood returning
to the heart, decreasing
preload, decreasing its
workload.
To provide nonpharmacological pain
management options and
relieve outside stress
factors.
Pathophysiology, Medical Treatment, Nursing Management:
Heart failure (HF) or Congestive Heart Failure (CHF) is a biological state in which the heart cannot pump enough blood
to meet the body’s metabolic due to any structural or functional damage of ventricular filling or ejection of blood. Heart failure results
from changes in the systolic or diastolic function of the left ventricle. The heart fails when, because of disease or structural issue it
cannot handle a normal blood volume or tolerate a sudden expansion in blood volume. Heart failure is caused by conditions such as
chronic hypertension, coronary artery disease, and valvular disease. Heart failure is a progressive and chronic condition managed by
lifestyle changes and medical therapy to improve quality of life. Some common medications can include:
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ACE Inhibitors / Angiotensin II Receptor Blockers – relax blood vessels to lower blood pressure and decrease strain on the
heart
Beta Blockers – Slow heart rate and reduce blood pressure and can reduce signs and symptoms of heart failure
Diuretics – Decrease fluid in the body
Aldosterone antagonists - Potassium-sparing diuretics that have additional properties that may help people with severe
systolic heart failure live longer.
Positive inotropes - Can help the heart pump blood more effectively and maintain blood pressure. Usually given via IV to
hospitalized patients.
Digoxin – Increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart
failure symptoms in systolic heart failure.
Nursing management for CHF patients would consist of frequent observation and cardiac assessments as well as monitoring of vitals
and telemetry. Nurses must administer ordered medications on time and make sure to observe patient for any changes.
Pre-Simulation Plan of Care
CAD
Student Name: Naylea Cabral
Date: February 6, 2023
Patient Initials: CS
Patient Age: 54 Years Old
Admitting Diagnosis:
CAD (Coronary Artery Disease)
CAD Pathophysiology:
Coronary artery disease is a common heart condition. The major blood vessels that supply the heart struggle to send enough blood,
oxygen and nutrients to the heart muscle. Cholesterol deposits, called plaques, in the heart arteries and inflammation are usually the
cause of coronary artery disease.
Medications:
Medications
Indications
Significant Side effects
Patient’s dose, route and
frequency; Normal dose
range
Nursing responsibilities
1.
Treats severe pain.
Nausea, vomiting,
constipation,
lightheadedness,
dizziness or drowsiness
may occur.
2.0 mg IV Push
Observe for any changes in respiratory rate
for respiratory depression.
Normal Dosage for adults:
Assess lung sounds, pulse, RR and BP before
and after administration medication.
GenericMorphine
Sulfate
Morphine will act as an
analgesic to reduce pain.
Trade MS Contin
Morphabond
Respiratory depression
2-10mg every 3-4 hours
as needed.
Patient is in dose range.
ClassificationOpioid Analgesic
Assess pain level before
medication administration.
and
after
2.
Generic –
Aspirin /
acetylsalicylic acid
Trade –
Bayer Plus
Aspir-Low
to treat pain and
reduce
fever
or
inflammation. It is
sometimes used to
treat or prevent heart
attacks, strokes, and
chest pain (angina).
Heartburn,
stomachache, nausea,
vomiting and irritation.
Generic:
Nitroglycerin SL
Trade: Nitrostat
Classification:
Vasodilators
Normal Dosage for adults:
Patient’s dose
normal range.
To treat angina.
Assess pain and limitation of movement;
note type, location, and intensity prior to
and at the peak following administration of
medication
325mg-650mg orally once
q4-6h.
Classification –
NSAID
3.
325mg Chewable Tablet
Dizziness, headaches,
nausea, burning in
tongue, and
lightheadedness.
is
in
1 tablet (1/150gr)
sublingual route.
Normal Dosage for adults:
2.5 to 6.5 mg 3 to 4 times
a day.
Patient’s dose is below
normal range.
Assess patient for chest pain and monitor
heart.
References:
Chronic obstructive pulmonary disease - statpearls - NCBI bookshelf. (n.d.). Retrieved February 7, 2023, from
https://www.ncbi.nlm.nih.gov/books/NBK559281/
Mayo Foundation for Medical Education and Research. (2021, December 10). Heart failure. Mayo Clinic. Retrieved February 7,
2023, from https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148
Mayo Foundation for Medical Education and Research. (2023, January 31). Echocardiogram. Mayo Clinic. Retrieved February 7, 2023,
from https://www.mayoclinic.org/tests-procedures/echocardiogram/about/pac-20393856
Mayo Foundation for Medical Education and Research. (2021, May 21). Pneumothorax. Mayo Clinic. Retrieved February 7, 2023, from
https://www.mayoclinic.org/diseases-conditions/pneumothorax/symptoms-causes/syc-20350367
Reference ID: 3043802 - food and drug administration. (n.d.). Retrieved February 7, 2023, from
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/202515s000lbl.pdf
Vallerand, A. H., & Sanoski, C. A. (2023). Davis's drug guide for Nurses. F.A. Davis.
Wikimedia Foundation. (2023, January 29). Complete blood count. Wikipedia. Retrieved February 6, 2023, from
https://en.wikipedia.org/wiki/Complete_blood_count
Wikimedia Foundation. (2023, February
https://en.wikipedia.org/wiki/Chest_radiograph
5). Chest
radiograph.
Wikipedia.
Retrieved
February
6,
2023,
from