CASE STUDY: MANAGEMENT OF PATIENT WITH COMPLICATION FROM HEART DISEASE.

1. George Brown, 72 years of age, is a made admitted with the diagnosis of acute pulmonary edema secondary to acute left ventricular heart failure. The patient has a history of coronary artery disease that has treated medically,. The patent is anxious , pale, cold, clammy, and dyspneic. The vital signs are: blood pressure 88/90 mmHg, heart rate 110bpm, respiratory rate 32, breaths/min, and temperature 97o F,. There are bubbling crackles and wheezing throughout the lung fields and the patient is raising frothy blood tinged clear sputum, The patient's admission weight is 100kg. (Learning Objective 4).

a, What first actions should nurse take and what are rationales for these action?

The physician ordered furosemide (Lasix) 40 mg IVP STAT

b, What are the actions of furosemide that will help the patient?.

c. What nursing actions should be implemented when administering a diuretic?.

2, Carl Edwards is a 75 year old man with heart failure,. Having sustained three myocardial infractions in the last 10 years, he has decreased left ventricular function, Mr, Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he present to the emergency department with fatigue, generalized weakness, and feelings, of "skipping" heartbeats,. Upon arrival, he is placed on the cardiac monitor, his vital signs are assessed, and IV is inserted. He currently denies chest pain, but is experiencing some shortness of breath, and is on 2L of oxygen via nasal cannula. (Learning Objective 1)

a. Which of his medications might be contributing to his symptoms of generalized weakness and heart irregularities.?

b. For what clinical manifestations should you assess to correlate to his left-sided heart failure?

c. How do his medications treat his congestive heart failure?

d. How does the hypokalemia affect the effects of Digitalis?