Question

Julia Cook is a 74-year-old retired secretary. Her medical history includes hypothyroidism, and hypertension. She suffered a myocardial infarction due to coronary artery disease 5 years ago. She was diagnosed with systolic heart failure 1 year ago and has been managed with lisinopril 40mg, metoprolol succinate 25mg twice a day and furosemide 20mg daily. Over the past 2 months, she is noticing increasing SOB with doing more basic ADL’s. Spironolactone has been added to her regime.

1. Explain how each medication she is on will help with the symptoms of systolic heart failure.?
2. What is her NYHA classification based on her symptoms?
3. Explain why spironolactone will improve her symptoms (not a diuretic)
4. Explain why she is on metoprolol succinate and not tartrate?
5. Which lab tests will the nurse monitor in this patient before giving the medications?
6. Which vital signs will the nurse want to know before giving these medications?

Answer 1

1. Firstly the mechanism of each drugs individually is

lisinopril =its a ace inhibitor .it blocks the renin angisotensin aldosterone system.It leads to excretion of sodium and water from kidneys thus reducing the blood pressure

metoprolol succinate= This drug is beta blocker.It acts on heart.Its blocks the adrenergic receptor of heart and reduces the heart beat

furosemide= its a loop diuretics .it acts on henles loop of nephron and helps in excretion of water and thus reducing blood pressure

Spirinolactone= Its a potassium sparing diuretics Also helps in excretion of water from kidney.Thus helps in reducing pressure

2.She is of nyha class 4

3.spirinolactone is potassium sparing drug. It reduces the water content in body and thus reducing the blood pressure and it prevents hypokalemia .So better help in breathlessness

4.metoprolol tartarate is either available as a intravenous drug or as a immediate release drug So we have take the medicine many times in a day.So succinates is preferred over tartarate

5.Lab test that have to be seen are

Renal function test

thyroid function test

Echo of heart

Biochemistry of blood mineral levels

6. VITALS TO BE SEEN ARE

PULSE

BLOOD PRESSURE

RESPIRATORY RATE

EDEMA