Question

C. What nursing actions should be implemented when administering a diuretic? 2. Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three myocardial infarctions in the last 10 years, he has decreased left ventricular function. Mr. Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he presents to the emergency department with fatigue, generalized weakness, and feelings of "skipping" heartbeats. Upon arrival, he is placed on the cardiac monitor, his vital signs are assessed, and an IV is inserted. He currently denies chest pain, but is experiencing some shortness of breath, and is placed on 2 L of oxygen via nasal cannula. (Learning Objective 1) a. Which of his medications might be contributing to his symptoms of generalized weakness and heart irregularities? b. For what clinical manifestations should you assess to correlate to his left-sided heart failure? c. How do his medications treat his congestive heart failure? d. How does the hypokalemia affect the effects of Digitalis?

Answer 1

2. a. Which of his medications might be contributing to his symptoms of generalized weakness and heart irregularities?

In the list of medication, Lasix is a diuretic which develops the adverse effect of hypokalemia. Hypokalemia is a condition which shows the symptoms of muscle weakness, weak and irregular pulse, generalized weakness, fatigue, abdominal distension, etc. Carl Edward symptoms of generalized weakness and heart irregularities are due to Lasix, as this result in hypokalemia.

b. For what clinical manifestations should you assess to correlate to his left-sided heart failure?

In Left-sided heart failure, the left ventricle is unable to pump the blood completely which results in a lack of exchange of gas in the lungs. Thus results in the clinical manifestation of shortness of breath, low oxygen saturation, crackles in breath sounds, and decreased cardiac output.

c.How do his medications treat his congestive heart failure?

Digoxin decreases the electrical conduction of the AV node and increases the contraction of the muscle to enforce the left ventricle output. Capoten is an ACE inhibitor, causes vasodilation of blood vessels. It also decreases the preload and afterload to reduce the resistance against left ventricle. Coreg is beta-blocker which controls the blood pressure and slows the heart rate. Lasix is a diuretic which prevents the retention of water and thereby decreases the preload.

d.How does the hypokalemia affect the effects of Digitalis?

Usually, digitalis is prescribed with diuretics. Hypokalemia leads to digitalis toxicity that causes low magnesium level which further contributes to low potassium level and leads to dysrhythmias.