Question

Case Study, Chapter 29, Management of Patients With Complications From Heart Disease

1. George Brown, 72 years of age, is a male patient who is admitted with the diagnosis of acute pulmonary edema secondary to acute left ventricular heart failure. The patient has a history of coronary artery disease that has been treated medically. The patient is anxious, pale, cold, clammy, and dyspneic. The vital signs are: blood pressure, 88/50 mm Hg; heart rate, 110 bpm; respiratory rate, 32 breaths/min; and temperature, 97°F. There are bubbling crackles and wheezing throughout the lung fields and the patient is raising frothy blood-tinged clear sputum. The patient’s admission weight is 100 kg. (Learning Objectives 1 and 6)

1. What first actions should the nurse take and what are the rationales for these actions?

The physician prescribed furosemide (Lasix) 40 mg IVP STAT.

2. What are the actions of furosemide that will help the patient?

3. What nursing actions should be implemented when administering a diuretic?

2. Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three myocardial infarctions in the last 10 years, he has decreased left ventricular function. Mr. Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he presents to the emergency department with fatigue, generalized weakness, and feelings of “skipping” heartbeats. Upon arrival, he is placed on the cardiac monitor, his vital signs are assessed, and an IV is inserted. He currently denies chest pain, but is experiencing some shortness of breath, and is placed on 2 L of oxygen via nasal cannula. (Learning Objective 1)

1. Which of his medications might be contributing to his symptoms of generalized weakness and heart irregularities?

2. For what clinical manifestations should you assess to correlate to his left-sided heart failure?

3. How do his medications treat his congestive heart failure?

How does the hypokalemia affect the effects of Digitalis

Answer 1

Case study 1;-

Nursing actions in Acute pulmonary oedema.

• Provide semi Fowler's or Fowler's position-to ease breathing
• Connect the patient to a cardiac monitor and monitor vital signs every 15 minutes.-to know the patient's status .
• Provide supplimentary oxygen as per the physician's order-to improve body's oxygen level.
• Administer Diuretic as per the order-to reduce circulating volume ,and thereby improving gas exchange.
• Serial ABG s-to the tissue perfusion .
• Maintain  Intake and output chart -to know the fluid balance.
• Monitor electrolytes as per order-to avoid arrhythmias resulting from electrolyte imbalances.

Actions of Furosemide in Acute pulmonary edema.

Its a Loop diuretic,which acts by reducing pre load through vasodilation and diuresis ,thus decrease

the pressure caused by excess fluid in heart and lungs.

Nursing actions when administering diuretic.

• Monitor BP and pulse before administering.-hypotension can occur with diuretics
• Monitor intake and output chart.-to know the fluid status
• Watch for drymouth ,lethargy, hypotension-excess fluid loss causes symptoms like this
• Proper Documentation in the medication chart and nurses notes.

Case study 2;-

Digoxin-causes fatigue and weakness,in digosxin toxicity patient may experience arrhythmias .[feeling of skipping heartbeat]

Capoten-Causes fatigue and drowsiness, also hyperkalemia can occur ,which is a cause for arrhythmias

Coreg-causes slow heartbeat

Lasix-causes hypokalemia,which is a reason for arrhythmia

Clinical manifestations of left sided heart failure-

• fatigue and generalised weakness,shortness of breath,rapid or irregular heart beat, shortness of breath while lie down

How the medications effects the treatment?

Digoxin-affecting sodium and potassium inside heart cell, this reduces strain on the heart which helps to maintain a strong steady and normal heartbeat.

Capoten-it causes vasodilation ,thus blood pressure is reduced, this makes easier for the heart to pump blood and can improve the function of a failing heart.

Coreg-it improve the left ventricular ejection fraction,thus reduce mortality rates in patients with heart failure.

Lasix-helps in diuresis,thus help the heart to pump easier.

How does hypokalemia affect digitalis effect?

Digoxin normally binds to the ATPase pump on the same site of potassium. With hypokalemia,digoxin can more easily bind to ATPase pump ,exerting the inhibitory effects, some times worsen the condition of dogoxin toxicity.