Fluid volume excess in acute exacerbation of left heart failure results from compensatory mechanisms that aim at countering decreased stroke volume and cardiac output (Lilly, 2011). Left heart failure results to cardiac and vascular changes that warrant such compensatory mechanisms as measure of meeting the normal demand of the circulatory system. During an acute exacerbation of left heart failure, some of the cardiac changes include decreased cardiac output and stroke volume, impaired filling and decreased ejection fraction. Among the vascular changes include an increase in systemic vascular resistance, impaired organ perfusion, increased blood volume and decreased arterial pressure (Rahko, 2013). As a result of these changes, compensatory mechanisms are triggered in a bid to restore normalcy. These compensatory mechanisms arise sympathetic nerve activation.

causes secretion of aldosterone hormone (Paralikar, Bungalows &Nargar, 2012). The results of these hormones are continued re-absorption of sodium ions and water. Although the compensatory increase in volume helps maintain cardiac output, it is disastrous since it leads to fluid volume excess and raises venous pressures, causing systemic and pulmonary edema.

B). Two nursing strategies to manage pulmonary edema as a result of fluid volume excess, with evidence-based rationales.

Management of pulmonary edema due to fluid volume excess in left heart failure should be taken as an emergency, because it interferes with the patient’s ability to breath. The goal of intervention should be reduction of pulmonary edema and improvement of tissue oxygenation. The first nursing strategy to the management of pulmonary edema is instituting the high fowlers position (Albert, 2012). As part of this strategy, the nurse may also place the patient in a sitting position, and with the patient’s legs dependent. However, this depends on the patient’s blood pressure. The rationale behind this strategy is to increase lung capacity and volume, easing the work of breathing. Additionally, this technique decreases the heart’s venous return.

(Albert, 2012). Alternatively, the nurse can administer ten to fifteen liters using a non-rebreather mask and a reservoir. The patient is then connected to a pulse oximeter and a cardiac monitor. The rationale behind this technique is to increase oxygen delivery concentrations. The aim is to keep the patient at a percentage partial pressure of oxygen that is above ninety.

1. (c). Mechanism of Action of Frusemide

Frusemide is a diuretic drug indicated for edema due to heart failure, renal disease, liver cirrhosis and nephrotic syndrome. The dosages range from twenty to eighty milligrams per oral once daily, or 20 to 40 milligrams intravenously once daily. Considering its mechanism of action, it is a loop diuretic (Rahko, 2013). As such, it works by inhibiting the re-absorption of chloride and sodium ions at the loop of Henle, distal and proximal renal tubules. Its interference with the co-transporter system and the chloride binding causes an increase in magnesium, water, calcium, chloride and sodium. Through such a mechanism, it reduces fluid in the body.

(d). Nursing implications with Frusemide in the management of edema in acute exacerbation of left heart failure.

While nursing a patient with Frusemide, the nurse should monitor vital signs and blood pressure carefully in patients receiving parenteral drugs. Frusemide should be administered alongside a potassium-sparing diuretic. In patients with decompensated hepatic cirrhosis and the diabetics, they should closely monitor hemoglobin A1c, blood glucose and urine (Lopes, Barros & Michel, 2009). Additionally, the nurse should be vigilant to monitor blood pressure during the periods of dose adjustments and diuresis. The nurse should be cautious with older patients and monitor for a likelihood of adverse drug interactions. It is also essential that the nurse obtains frequent lab tests, including blood-urea-nitrogen, carbon dioxide, blood count, uric acid values, blood sugar, and serum and urine electrolytes. This is done, especially in the first few months of Frusemide therapy. Thereafter, it is done periodically.

The aspect of patient and family teaching is also the responsibility of the nurse. The patient is advised n ingestion of potassium-rich foods (Albert, 2012). The nurse also teaches the patient about the course of their disease, the drugs, their mechanisms of actions and importance

References

Albert, M. N (2012).Fluid management strategies in heart failure.Critical Care Nurse, 32(2), 20-33.

Lopes, L.J., Barros, B.L., & Michel, M.J. (2009). A pilot study to validate the priority nursing interventions classification interventions and nursing outcomes classification outcomes for the nursing diagnosis “Excess fluid volume” in cardiac patients. International Journal of Nursing Terminologies and Classfication, 20(2), 76-89.

Lilly, S.L. (2011).Pathophysiology of heart disease: A collaborative project of medical students and faculty. Hoboken, NJ: Lippincott Williams & Wilkins.

Paralikar, J.S., Bungalows, T., & Nagar, S.N. (2012).High altitude pulmonary edema-clinical features, pathophysiology, prevention and treatment.Indian Journal of Occupational and Environmental Medicine, 16(2), 59-63.

Rahko, S.P. (2013). Heart failure: A case-based approach. New York, NY: Demos Medical Publishing.