Question

A 73-year-old patient who is being managed for viral cardiomyopathy with heart failure is going home today after an acute exacerbation of his heart failure. He has been taking furosemide 40 mg orally daily, rivaroxaban 20 mg orally daily, lisinopril 5 mg orally daily, and carvedilol 25 mg orally twice daily. He is now being prescribed to also take magnesium 500 mg orally once daily. He tells you that he understands why he is to continue to take the previously prescribed drugs but wants to know how the magnesium will help him. Your responsibility is to help him become a partner in his therapy to prevent worsening heart failure.

Questions (10 POINTS TOTAL)

1. Is this patient at risk for dehydration or fluid overload? Explain this risk.

(2 POINTS)

2. What parameters will you teach him to self-monitor at home for indications of needing to see the health care provider? Provide a rationale for your selection.

(2 POINTS)

3. What electrolytes are most likely to be disturbed by his drug therapy? Explain your selections and the directions of the potential disturbances. (2 POINTS)

4. What will you tell him about the magnesium? (2 POINTS)

5. What members of the interprofessional team would be most helpful in this patient’s management and why? (2 POINTS)

Answer 1

1.The medication furosemide will increase the urine output and may put patient at risk for fluid loss.Similarly drugs like lisinopril and carvedilol can alter the peristalsis and can lead to increased bowel movements causing diarrhea and loss of fluids and electrolytes causing dehydration .More over carvedilol is a water pill cause water loss and dehydration.

2.The patient has to be taught about ths adverse reactions and shoykd report in case of any severe or new symptoms

• Monitoring blood pressure as there are chance of hypotension and dehydration
• Monitor urine output
• Report in case hypotension, hematuria,malena,chest pain,fatigue, unusual bleeding ,hemolysis

3.Sr.Electrolyte

• sodium can decrease because as use of furosemide will lead to excretion of fluid from the body
• potassium can increase because of lisinopril altering the function of cell leading to imbalance
• increased magnesium because of magnesium
• Blood glucose level can increase because of carvedilol

4.The medication magnesium can prevent heart failure by preventing cardiac repolarization .It acts on the cellular level by pumping the sodium and potassium correctly and preventing sodium retention intracellular and preventing cardiac complications