Alfred, a 72-year-old recently diagnosed with right and left-sided…

Alfred, a 72-year-old recently diagnosed with right and left-sided heart failure, presents with +2 pitting edema in bilateral lower extremities, shortness of breath, ascites, weakness, and unproductive cough.Vitals upon presentation: 

T: 99.6, HR: 89, BP: 160/93, RR: 32. There is evidence of a 14 lb weight gain since his last visit two weeks prior. Alfred was admitted to the cardiac floor; the treatment plan was to start him on Diuretics and an Lisinopril. The provider started him on furosemide 80 mg IVP BID, with the first dose stat. His daughter has several questions for you regarding this new drug and is asking about the MECHANISM OF ACTION .

1. Describe the MECHANISM OF ACTION of furosemide and what it is doing in the kidneys:

2. How will this drug improve Alfred’s symptoms?3. What labs will need to be monitored with administration list all potential adverse effects and how they will be impacted. Also, list correlating symptoms: (Circle the priority lab):

a. Fluid Volume: Desired outcomes:__________Potential risk______________.

b. Sodium: (example: hypo or hyper)

c. Potassium:

d. Magnesium:

e. Calcium:

f. BUN:

g. Creatinine:

h. Uric Acid:

 

4. Describe RAAS:

5. The daughter is also asking you to explain the mechanism of action of Lisinopril, and she wants details of how this drug will reduce her father’s blood pressure to improve his heart failure.

6. Alfred will receive his first dose of Lisinopril; what adverse effects do we need to monitor with the administration of LISINOPRIL?

7. How will LISINOPRIL affect Alfred?

8. Later that night, Alfred complains of ringing in his ears. How do you explain this, and what is your action:

9. The next day Alfred complains that he has a persistent and disruptive dry cough and is very upset because it kept him up all night. What is the explanation of this phenomenon, and what do you anticipate the provider’s actions to be?

10. When you assess Alfred, you note that his lips and tongue are pretty swollen, eyes are also swollen shut. He looks like Will Smith from the movie HITCH Click here. What is this adverse reaction called? The provider changed Alfred, discontinued the LISINOPRIL, and started him on Losartan. The next day, you are charting in the nursing station and receive a call from the monitor tech informing you that Alfred is in Atrial Fib with heart rates in the 120s and Blood pressure of 140/82. The provider was contacted, and you received orders for Digoxin and a Calcium Channel Blocker- Verapamil. The daughter was also notified.

11. She inquires about the mechanism of action for the Verapamil and states: So does this drug just block calcium uptake? So how does that affect their heart and blood pressure in improving his hemodynamics? Explain.

12. She continues, “well if he is already getting something for his heart rate why are they starting him on digoxin as well. I am so confused.” How will you explain how the combination of these to drug work together?

13. The daughter is upset because the CNA took Alfred’s grapefruit juice away. She explains that grapefruit juice has been his favorite drink ever since he could walk. Why is this a problem with his plan of care?

14. It’s 12:30 pm, and the charge nurse approaches you and informs you that she has received acomplaint from Alfred’s daughter because all of the snacks she brought in for her father were removed by staff. (Snacks included bacon-extra crispy, Salt and Vinegar Chips, and pickles). Why do you think the 

15. You realized that the patient and family will require in depth patient education about CHF management. What points will you discuss regarding managing heart failure and his treatment plan (medication therapy).

16. Why is drug therapy so important for adherence in reducing risk? What does untreated heart failure would lead to…

17. What is the goal of therapy when treating patients with atrial fib?

18. What is a common problem with in treating dysrhythmia with antiarrhythmic medication(consider priorities) Balancing risks and benefits?

 

 

 

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