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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?

 

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.

 

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 three 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) 125mcg 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 2.2mEq/L 

b. Serum sodium level of 139mEq/L 

c. Apical heart rate of 64 beats/minute 

d. Digoxin level 1.6ng/mL 

 

10. When you go to give the digoxin, you notice that it is available in milligrams (mg) not micrograms (mcg). Convert 125mcg 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, what key management concepts should be taught to prevent relapse and another admission?

SCIENCE
HEALTH SCIENCE
NURSING
NURS 211L