Question

Case Study, Chapter 44, Cardiotonic Agents

A student nurse is preparing drug cards for clinical. The student nurse has to prepare a written teaching plan for a patient who is receiving digoxin. Other medications that will be administered during the clinical day include inamrinone. During clinical preconference, the student nurse has to do a 5-minute presentation on heart failure. (Learning Objectives 1, 5, and 6)

1. What is the pathophysiologic process of heart failure and the resultant clinical signs?
2. What are the therapeutic actions and indications for digoxin?
3. What are the most common adverse reactions for inamrinone?
4. What important teaching points need to be included for a patient receiving digoxin?

Answer 1

ANSWER

*Pathophysiological process in heart failure.

     * Impairment occur in the contraction or systolic function and

       filling of heart or diastolic function due to valve problems,infections

       age related changes etc.

    * Impairment affecting the functional activity of heart leads to reduction

       in pumping activity of heart and cardiac output lower than normal.

    * Decreased cardiac output leads to increased workload of heart and

      resistance to proper filling of heart.

    * Increased workload directly affect the cardiac muscles which leads to

       heart failure.

* Clinical signs.

        In left sided heart failure.

                    * Pulmonary congestion.

                    * Tachycardia.

                    * Dyspnea and non productive cough.

                    * Bibasilar crackles.

                    * Inadequate tissue perfusion.

                    * Orthopnea.

                    * Blood tinged sputum.

        In right sided heart failure.

                    * Edema of lower extremities.

                    * Ascites.

                    * Congestion of pheripheral tissues.

                    * Weight gain.

                    * Weakness.

                    * Hepatomegaly.

*Therapeutic action and indication of digoxin.

           * Therapeutic action

                    * Digoxin inhibit the enzyme sodium pottasium ATPase or

                      sodium pump on the cardiac myocytes.

                    * Sodium pump inhibition leads to increase intracellular sodium

                       and calcium.

                    * So myocardial cells get more calcium for contraction of heart.

                    * This result in increase the velocity and force of contraction.

           * Indications

                    * Digoxin used in

                              * Congestive cardiac failure.

                              * Atrial flutter.

                              * Atrial fibrillation.

                              * Paroxysmal supraventricular tachycardia.

* Common adverse reactions of inamrinone.

                         * Cardiac arrythmias.

                         * Hepatotoxicity.

                         * Hypotension.

                         * Thrombocytopenia.

                         * Chest pain.

                         * Fever.

* Teaching points for patient receving digoxin.

              * Inform patient about symptoms of overdose like blurried vision

                naused ,vomiting,bradycardia,skin rash,diarrhea tec and seek

                treatment immediately if it occur.

              * Use pottasium supplements along with digoxin therapy to avoid

                hypokalemia which is a side effect of digoxin therapy.

              * Teach patient to drink adequate fluids because dehydration during

                digoxin therapy leads to overdose or toxicity.

              * Take the same brand of digoxin as per physician order because different

                 brands contain different amount of active drug.

              * Instruct the patient to take a low sodium and pottasium supplement diet to

                avoid hypokalemia and hypernatremia.