Question

1. Discuss how each of these medications work in treating heart failure: diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, aldosterone antagonists, direct renin inhibitors, beta blockers, digoxin, dopamine, and hydralazine. What are some nursing considerations for each medication?

2. What are the signs and symptoms of digoxin toxicity? What are some steps you will take in treating a patient who has developed this?

3. Discuss how each of these medications work in treating cardiac arrhythmias: quinidine, procainamide, amiodarone, propranolol. What are some nursing considerations for each.

4. Discuss some teaching points for your patient being prescribed oral nitroglycerine for angina pectorus.

Answer 1

1) How this medication work in heart failure:

a) Diuretics: it inhibits sodium and water reabsorption.

Nursing consideration: monitor the fluid balance ( both output and input)

b) Angiotensin-converting enzymes:  

• it interferes with the hormones that narrow blood vessels thus promoting good blood supply.
• thus reduce blood pressure and reduce the workload on the heart.

Nursing consideration:

• monitor for high blood pressure
• advice the patient to avoid hazardous works

c) Angiotensin II receptor blockers:

• it inhibits the substance that narrow blood vessels
• as a result, the blood vessels relax and widen
• thus making the blood to flow through the vessels
• therefore, blood pressure reduces which makes the heart to pump easier

Nursing consideration:

• monitor for edema
• change the position slowly

d) Aldosterone antagonists:

• it helps the kidney to produce more urine.
• thus more amount of water and salt are flushed out of the body.
• thus it makes easier for your heart to pump easier.

Nursing consideration: monitor the blood pressure as there is a chance to increase in 4 weeks.

e) Direct renin inhibitors:

• it blocks the renin which triggers the blood pressure
• as a result, blood vessels relax and widen
• thus blood flow will be easier.

Nursing consideration: monitor the patient closely for any side effects.

f) Beta-blockers:  

• it slows the heart rate and allows more time to fill blood in your heart

Nursing consideration:

• check apical and radial pulse
• monitor blood glucose level
• monitor blood balance ( both output and input)

g) Digoxin:

• it strengthens the force of heart muscles
• helps to restore normal steady heart rhythm and increase blood circulation

Nursing consideration:

• monitor apical pulse for 1 full minute before administering
• withhold if the heart rate is lower than 70bpm in adults and children and 90 in infants.

h) Dopamine :

• it increases the pumping strength of the heart and improves blood flow to the kidney.

Nursing consideration:

• monitor blood pressure, peripheral pulse, every 15 minutes
• notify the physician if oliguria and tachyarrhythmias develop.

i) Hydralazine: it increases cardiac output and stroke volume.

Nursing consideration:

• weight the patient twice a week and examine the feet and ankles for fluid retention.

2) Digoxin toxicity:

Signs and symptoms: it can occur in the acute and chronic stage

Acute stage:

• nausea
• vomiting
• vertigo

Chronic stage: nonspecific symptoms are the main such as

• fatigue
• malaise
• visual disturbance

There are some classic signs and symptoms like:

• abdominal pain
• headaches
• dizziness
• confusion
• delirium
• cardiac disturbance such as ( irregular heartbeat)

Treatment :

Digoxin immune fab is the best treatment option for toxicity by using this

• this immune fab is made up of anti-digoxin immunoglobulin
• which form complexes with the digoxin molecules
• thus excreted out through the urine.

3) How this medication work in cardiac arrhythmia: all these drugs work to slow down the electrical impulses thus, stop the arrhythmias.

a) quinidine

Nursing consideration:

• monitor ECG and blood pressure
• stop the drug if the heart rate is 120 bpm

b) procainamide

Nursing consideration:

• check radical and apical pulse before each dose
• monitor ECG and blood pressure regularly

c) amiodarone

Nursing consideration:

• check pulse regularly and notify if less than 60 bpm

d) propranolol

Nursing consideration:

• monitor blood pressure and pulse daily.

4) Education for oral nitroglycerine:

• ask them to inform any side effects ( such as burning sensation in the mouth)
• seek emergency if chest pain occurs and experience trouble breathing, feel weak, dizzy and nauseated.
• do not stop taking it suddenly
• do not use 2 does at one time
• avoid driving and hazards activity
• avoid getting up too fast from a sitting or lying position which makes you feel dizzy
• reduce the intake of alcohol.