Question

pahrmacology

Assignments, Chapter 44, Cardiotonic Agents Learning Objective(s) 12 Written Assignments 1. Describe the pathophysiology of heart failure. What are the clinical signs and symptoms of heart failure? 2. Explain how the compensatory mechanisms for heart failure work to maintain cardiac function. What occurs if these mechanisms begin to fail? 3. List three essential nursing measures required to be implemented when using digoxin in pediatric patients. 4. What nursing measures should be implemented when working with older adults using cardiac glycosides? What are the signs and symptoms of digoxin toxicity and why are older adults at a higher risk? Learning Objective Group Assignment 1. Construct a table comparing the cardiac glycosides, the phosphodiesterase inhibitors, and the digoxin antidotes. For each drug group, describe the therapeutic actions, indications, pharmacokinetics, contraindications, the most common adverse reactions, and the important drug-drug interactions for each group.

Answer 1

1. Pathophysiology of heart failure :-

- decrease in contractility

- decrease in preload

- increase in afterload

#. Sign and symptoms of heart failure are :-

Peripheral edema w/o venous insufficiency

Pulmonary rales not cleared with coughing

Elevated JVP

Positive Hepatojugular Reflex

Third heart sound (S3)

Apical pulse displaced laterally

Generalized symptoms

Fatigue

Weakness

Decreased exercise tolerance

GI symptoms include :-

Nausea

Anorexia

Pain

Tenderness

Neurological symptom :-

Unexplained confusion

Respiratory symptoms include :-

Dyspnea on exertion

Orthopnea

Paroxysmal nocturnal dyspnea

Dry, hacking couch, especially when supine

2. Compensatory mechanism for heart failure :-

Compensatory mechanisms to maintain cardiac output in HF

1) frank starling mechanisms- length dependent --> seconds

2) autonomic nervous system baroreceptor response --> seconds

3) renal compensation by RAA --> seconds to hours

4) ventricular remodeling myocardial hypertrophy or dilation --> weeks to years.

3. Three essential nursing measures required to be implemented when using digoxin in pediatric patients are :-

- MONITOR APICAL PULSE FOR 1 FULL MINUTE BEFORE ADMINISTERING.

- WITHHOLD DOSE & NOTIFY HCP IF PULSE < 60.

- ALSO NOTIFY HCP PROMPTLY OF ANY SIGNIFICATION CHANGES IN RATE, RHYTHM , OR QUALITY OF PULSE.

4. Nursing measures that should be implemented when working with older adults using cardiac glycosides are :-

• Ascertain apical pulse rate before administering __. DO NOT administer if pulse rate <60 beats/min.

• Determine signs of peripheral and pulmonary edema, which indicate HF is present.

• *Monitor serum __ level (normal therapeutic drug range is 0.8-2 ng/mL). A serum __ level greater than 2 ng/mL is indicative of digitalis toxicity.

• *Monitor serum potassium level (normal range is 3.5 to 5.3 mEq/L), and report if hypokalemia (<3.5 mEq/L) is present.

#. Sign and symptoms of digoxin toxicity are :-

- anorexia

- nausea and vomiting

- diarrhoea

- visual disturbance

- mydriasis

- confusion

- fatigue

- restlessness

- weakness

- headache

- depression

- hallucinations

- vertigo

- neuralgia