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M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can’t catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge.

 

1. What error in teaching most likely occurred when M.G. was discharged 10 days ago?

 

During the admission interview, the nurse makes a list of the medications M.G. took at home.

Chart View

Nursing Assessment: Medications Taken at Home

Enalapril (Vasotec) 5 mg PO bid

Pioglitazone (Actos) 45 mg PO every morning

Furosemide (Lasix) 40 mg/day PO

Potassium chloride 20 mEq/day PO

 

2. Which of these medications may have contributed to M.G.’s heart failure? Explain.

3. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work to reduce heart failure? (Select all that apply.) ACE inhibitors:

a. prevent the conversion of angiotensin I to angiotensin II.

b. cause systemic vasodilation.

c. promote the excretion of sodium and water in the renal tubules.

d. reduce preload and afterload.

e. increase cardiac contractility.

f. block sympathetic nervous system stimulation to the heart.

After reviewing M.G.’s medications, the physician writes these medication orders:

 

Chart View

Medication Orders

Enalapril (Vasotec) 5 mg PO bid

Carvedilol (Coreg) 100 mg PO every morning

Glipizide (Glucotrol) 10 mg PO every morning

Furosemide (Lasix) 80 mg IV push (IVP) now, then 40 mg/day IVP

Potassium chloride (K-Dur) 20 mEq/day PO

 

4. What is the rationale for changing the route of the furosemide (Lasix)?

5. You administer furosemide (Lasix) 80 mg IVP. Identify five parameters you would use to

monitor the effectiveness of this medication.

6. What laboratory tests should be ordered for M.G. related to the order for furosemide (Lasix)? (Select all that apply.)

a. Magnesium level

b. Sodium level

c. Complete blood count (CBC)

d. Serum glucose levels

e. Potassium level

f. Coagulation studies

 

7. What is the purpose of the beta blocker carvedilol? It is given to:

a. increase the contractility of the heart

b. cause peripheral vasodilation

c. increase urine output

d. reduce cardiac stimulation by catecholamines

The next day, M.G. has shown only slight improvement, and digoxin (Lanoxin) 125 mcg PO daily is added to her orders.

 

8. What is the action of the digoxin? Digoxin:

a. causes systemic vasodilation.

b. promotes the excretion of sodium and water in the renal tubules.

c. increases cardiac contractility and cardiac output.

d. blocks sympathetic nervous system stimulation to the heart.

 

9. Which findings from M.G.’s assessment would indicate an increased possibility of digoxin

toxicity? Explain your answer.

a. Serum potassium level of 2.2 mEq/L

b. Serum sodium level of 139 mEq/L

c. Apical heart rate of 64 beats/minute

d. Digoxin level 1.6 ng/mL

 

10. When you go to give the digoxin, you notice that it is available in milligrams (mg) not

micrograms (mcg). Convert 125 mcg to mg.

11. M.G.’s symptoms improve with IV diuretics and the digoxin. She is placed back on oral

furosemide (Lasix) once her weight loss is deemed adequate to achieve a euvolemic state. What will determine whether the oral dose will be adequate to consider her for discharge?

12. M.G. is ready for discharge. Using the mnemonic MAWDS (medications, activity, weight, diet, symptoms), what key management concepts should be taught to prevent relapse and another admission?

SCIENCE
HEALTH SCIENCE
NURSING
NUR 2222