Question

Answer the questions based on the following scenario 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

Additional Assessment:

The nurse should

• assess for Past medical history and medication were taken.
• Assess the family history
• Assess for the physical mobility and limitation of movement.
• Assess the lung sounds for the presence of crackles.
• Lifestyle patterns and dietary habits.
• Monitor ECG and rhythm status.

Priority problem:

• Shortness of breath on exertion
• Hypokalemia
• Pitting edema
• Loss of appetite

Nursing intervention:

• Make a comfortable position.
• Elevate the legs to minimize swelling and improve venous return.
• Administer potassium-sparing diuretics to increase the elimination of urine and decrease edema.
• Potassium supplement to correct hypokalemia.
• Plan a diet plan

Medication:

Digoxin:

It strengthens the contraction of the force of cardiac muscle and increases cardiac output. Thereby it relives the accumulation of fluid and relieves the pulmonary and cardiac symptoms.

Captopril:

Captopril has a vasodilator activity which is the best alternative for digoxin. It is an ACE inhibitor, which is effective in treating of both hypertension and heart failure.

Diuretics:

Potassium-sparing diurtic such as thiazide or loop type should be administered to reduce fluid overload and improve cardiac function.

Lab work:

Lab results show that the patient is hypokalemia. The patient also had a low glucose level. So the nurse has to ask the doctor for the correction of hypokalemia and to maintain normal blood glucose levels. Lasix can further decrease the potassium level. So the alternative of Lasix and digoxin should be checked from the doctor.