Question

Jerry Stein, 76 years old, was hospitalized for complaints of increased shortness of breath (SOB) and cough. He had noticed swelling around his ankles. On admission he had crackles mid-to base bilaterally. Labs reveal a BNP of 625. Mr Stein has a history of Type 1 diabetes mellitus. He was diagnosed with chronic heart failure (CHF). He was started on multidrug therapy and discharged. He returns to the outpatient clinic 10 days later complaining of blurry, yellowed vision, anorexia, nausea, and “just not feeling right.” Data obtained from the nursing assessment include the following: Mild, peripheral edema Heart sounds normal, no S3 Lung sounds have a few scattered crackles but are otherwise clear. Vital signs: temperature, 97.8°F; pulse, 54; respirations, 12; blood pressure, 140/90 Allergies: Sulfa The patient’s current medication therapy includes digoxin, 0.25 mg PO qd; hydrochlorothiazide, 25 mg PO qd; and captopril, 25 mg PO tid. Why is Mr. Stein on each of these drugs? Are there any assessment findings that would influence the administration of any of the drugs? What is the significance of his hx of diabetes? Which findings from the nursing assessment demonstrate the effectiveness of drug therapy? Which findings from the nursing assessment demonstrate possible adverse effects from drug therapy? What changes, if any, would you anticipate in his drug therapy related to your assessment of the patient? What teaching is required for Mr. Stein regarding his drug therapy? Do you need any additional data to determine appropriate teaching?

Answer 1

1 Digoxin is given to the rythm regular.It is used to treat atrial fibrillation.IT is used to treat symptoms of heart failure.Since Mr Stein is suffering from Chronic Heart failure ,that maybe the reason why it hasbeen prescribed.Hydrothiazide is used for the treatment of hypertension,congestive heart failure,Symptomatic edema,diabetes insipidus and renal tubular acidosis.A dose of 12.5mg to 25mg maybe given in Hypertension,initial 25mg PO q8-12hr ,increase gradually based on response.it is given in CHF with diuretics and digitalis.it is highly beneficial in patients who has a new onset of DM.

2Tab Captopril should be discontinued if there is symptoms of jaundice.

3 Peope with history of diabetes mellitus have an elevated risk of heart disease.They have two or four times more likely to die of heart disease.The connection between diabetes and heart disease starts with high blood sugar levels.Overtime ,the high glucose in blood stream can damage the arteries,causing them to become stiff and hard.Fattymaterial accumulates in the blood vessels which block blood flow to the heart leading to stroke.

4 Treating an irregular heartbeat can decrease the risk for blood clots.Tab digoxin helps in treating irregular heart beat and reduces the pulse rate.So frequent monitoring of pulse rate is required and adjust the dosage if the pulse rate decreases.