Question

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

Answer 1

1. George Brown

Acute Left ventricular failure

Left ventricular failure is characterised by the dysfunction of left ventricle that causes insufficient pumping of blood to other parts of the body especially the important body organs such as brain, liver, lungs and kidney.

A) Nursing actionss : ( Other than vital signs monitoring and basic assessment of Mental status, skin, breath sounds, ABG)

* Position patient in high fowler's or semi fowler's position , support the arms with pillows

Rationale: This position helps to expand chest volume, makes  breathing easy.

* Administer oxygen as per physician's order

: To increase oxygen supply to the tissues ( to prevent hypoxemia)

* Administer Bronchodialators( to dialate air ways), diuretics ( decreases alveolar congestion) as per physician's order

* Help the patient to use relaxation techniques

: To reduce stress and muscle tension , it can decrease work of breathing.

2. Carl Edwards

Congestive Heart failure

A syndrome marked by weakness, edema and shortness of breath , due to inability of the heart to circulate the blood adequately to the lungs and other tissues.

a. Digoxin , Capoten and lasix

Digoxin: used to treat hear failure. It reduces strain on the heart by affecting Sodium, potassium minerals. Other than the common side effects such as nausea, vomiting, head ache, it may cause weekness and irregular heartbeat ( skipping of heart beat).

Capoten: It is used to treat high Blood pressure and heart failure and it is an ACE inhibitor ( Angiotensin Converting Enzyme inhibitor). It is also used to treat heart failure along with other medications, it helps to survive the heart after an attack. One of the less common side effect of this drug is irregular heartbeat and rarely it causes unusual weekness or tiredness.

Lasix: It is a diuretic and helps to reduce the symptoms of swelling of arms and legs and shortness of breath( due to Pulmonary congestion ) Head ache, blurred vision, dizziness are the common side effects, other than these symptoms, it also may cause weakness and irregular heartbeat.

b) Clinical manifestations for Left sided heart failure

* Shortness of breath ( fluid build up in lungs due to insufficient pumping of left ventricle)

* fatigue

* irregular heartbeat

c) ( Answer is given in the description of drugs for answer 'a')

Coreg: used to treat heart failure along with other medications . It reduces blood pressure, there by preventing heart attacks and strokes. It blocks the actions of epinephrine on heart and lowers the strain on heart.

d) Hypokalemia and digitalis

Hypokalemia is a condition of having an abnormally low concentration of potassium ions in the blood. Hypokalemia in patients who take digitalis may get Digoxin toxicity.

Digoxin poisoning or digoxin toxicity can be caused due to hypokalemia. Usually digoxin bind with ATPase pump at the same site of potassium. When there is less potassium, digitalis( digoxin) can easily bind to the ATPase pump than usual. It leads to increased concentration of digoxin in the blood.