Question

Mrs. G is an 83 y/o female admitted with worsening heart failure. She was getting increasingly fatigued and "gets winded just walking out to the mailbox to get her mail.   She also is crying because her rings do not fit and she is waking up at night with trouble breathing. Sometime she forgets to take her medicine and she has had a poor appetite, and sometimes eats a little toast and has some milk for dinner.

Admission labs are

• Sodium 138
• Chloride 102
• Potassium 2.9
• Glucose 93

She has an EKG that shows Normal Sinus Rhythm at 72

The doctor has reordered her home meds listed below

• Digoxin 0.25 mg po every morning
• Lasix 40 mg po every morning
• Metoprolol XL 25 mg po daily

The nurse assesses the patient:

• Dyspnea with exertion and needs HOB elevated to be able to breath while in the bed.
• Has 2 plus pitting edema in feet, ankles, and lower legs
• Says not eating because feels full all the time
• VS T 97.7, Apical heart rate is 64, RR is 22, Pulse Oximetry is 92% on room air.

What additional assessment should the nurse complete on this patient before calling the doctor with assessment and lab findings?

Identify a priority nursing problem and at least 3 interventions the nurse should institute at this time

The nurse is concerned about the lab work and the current medication list.

Explain what each medication is for in the treatment of heart failure.

Explain which medication the nurse is concerned about giving and why

Explain what lab work is concerning and what the nurse is going to ask for from the doctor.

What drug class might have been used in place of digoxin?

Answer 1

The additional assessment needed are

• The blood pressure of the patient to be measured as patient is on antihypertensive drug and a case of heart failure
• The intake and output has to be monitored as the patiwnt is exhibiting fluid retention
• Ausculate the heart for murmurs as it occurs in heart failure ,crackles in the lung
• Mental status examination for confusion,muscular system for muscle cramps ,tingling sensation, cramps,spasms,fatigue due to hypokalemia
• Complaints of nausea ,vomiting, constipation can occur in low potassium level

Impaired gaseous exchange related to heart failure as evidenced by low oxygen saturation, trouble breathing

Goal:To maintain normal breathing

Nursing intervention and rationale

• Monitor vital signs to get baseline data
• Administer oxygen to relieve breathing difficulties due to low oxygen level
• Restrict fluid intake to prevent fluid retention
• Provide propped up position to increase the lung capacity

Evaluation :

Patient should be able to breathe easily

The nurse is concerned about the medication like lasix which can cause electrolyte imbalances,metoprolol causing anorexia,shortness of breath.

Digoxin is a cardiac glycoside which enables the pumping of the heart

Lasix is a diuretic with antihypertensive drug help a to remove extra fluid from body and maintains normal blood pressure

Metoprolol acts mainly by controlling the heart beat and blood pressure

The nurse should be concerned about digoxin, when there are other effective drugs compared to it

The extreme low level of potassium is a concerned which has to be informed to the physician which needs immediate action

Instead of digoxin calcium channel blocker or beta blocker can be used