(^104) Medical-Surgical Nursing Demystified
NURSING INTERVENTION
- Monitor respirations looking at rate, effort, use of accessory muscles, skin
color; listen to breath sounds. - Place patient in high Fowler’s position to ease respiration.
- Weigh the patient daily. Excess fluid due to heart failure will increase weight.
Notify physician, NP, or PA of weight gain of 2 pounds in 24 hours. - Have the patient perform the turning, coughing, and deep-breathing exer-
cises to enhance lung expansion and expel mucous. - Monitor sputum for changes in color or amount, which may signal infection
in patients with chronic bronchitis. - Monitor intake and output.
- Increase fluids to keep mucous thinner and easier to expel.
- Explain to the patient:
- How to administer oxygen.
Cor Pulmonale
WHAT WENT WRONG?
In Cor Pulmonale, the structure and function of the right ventricle are compromised
by chronic obstructive pulmonary disease (COPD), obstruction of the airflow into and
out of the lungs. The heart tries to compensate, resulting in right-sided heart failure.
The patient has heart failure due to a primary lung disorder, which causes pul-
monary hypertension and enlargement of the right ventricle. Patients will have
symptoms of both the underlying pulmonary disorder and the right-sided heart
failure. COPD includes chronic bronchitis and emphysema.PROGNOSIS
Management of both the underlying lung disease and the heart failure is necessary
to alleviate the symptoms for the patient. Medical management may provide sig-
nificant relief of symptoms for the patient. Exacerbations of the underlying disease
process are still likely. Progression of the disease state is possible, requiring adjust-
ment in medications or further lifestyle modifications.7