Reference no: EM133919094

Question

Critical Thinking Activities -Heart Failure

1. A nurse administered 125 mg of digoxin instead of 0.125 mg intravenously. The patient has developed a severe heart block dysrhythmia, and the slow heart rate has not responded to administration of atropine and other measures. The nurse stays with the patient while the charge nurse notifies the health care provider. What will be the priority in this situation? What will the nurse expect to give next? How could this situation have been prevented?

2. A nurse is making morning medication rounds. One patient, a 78-year-old-man, states that he has been nauseated and without an appetite and has experienced some diarrhea. He has been taking digoxin for the past few weeks for the treatment of recently diagnosed heart failure. What is the nurse's priority action? Explain your answer.

3. A patient is receiving an ACE inhibitor, a diuretic, and a β-blocker as treatment for mild heart failure. He has a history of hypothyroidism-which is controlled by thyroid replacement hormones-and chronic bronchitis. He states that he stopped smoking a year ago, after smoking two packs of cigarettes a day for 30 years. This morning, he reported a dry cough but said he does not feel short of breath, even when getting up to go to the bathroom. He is unable to produce any sputum. When the nurse listens to his lungs, his breath sounds are clear except for a few scattered rhonchi bilaterally. His weight is the same as the previous morning, and his ankles show only trace edema (2 days ago, he had 2+ edema on the edema scale). His temperature is 36.9°C (98.4°F), his pulse is 88 beats per minute, and his blood pressure is 124/86 mm Hg. He says to the nurse, "This cough is awful! I am so afraid that my heart failure is getting worse or that I'm getting pneumonia!" What is the nurse's priority action?

Case study Chapter 25: Heart Failure Drugs: Phosphodiesterase Inhibitor for Heart Failure

Devon, a 58-year-old retired bus driver, has been in the hospital for a week for treatment of heart failure. He had a myocardial infarction a year ago and tells the nurse that he "hasn't felt well for weeks." He is currently receiving carvedilol, lisinopril, furosemide, and potassium supplements (all orally), but he has had little improvement. Today during morning rounds, the nurse notes that Devon is having increased difficulty with breathing, and his heart rate is up to 120 beats per minute. His weight has increased from 72 to 76 kg overnight, and his lower legs and ankles show edema rated as 3+. Crackles are heard over both lungs, and his pulse oximetry reading is 91% (down from 98% earlier). In addition, Devon is very restless. Oxygen is started, a Foley catheter is inserted, and Devon is transferred to the intensive care unit.

After examining Devon, the health care provider writes new medication orders as follows: Change furosemide to 60 mg intravenously twice a day Continue carvedilol and lisinopril Start an infusion of milrinone as follows: Loading dose: 50 mcg/kg over 10 minutes, followed by an infusion of 0.5 mcg/kg/min

1. Describe the drug effects of the medications Devon is receiving for his heart failure.

2. What laboratory values will you need to monitor while Devon is receiving the milrinone?

3. Identify the potential problem.

4. Are there any additional concerns? What will the nurse need to do at this point?

5. In addition to being given education regarding his medications, what should Devon be taught to monitor while recovering at home?

Case Study Chapter 27: Coagulation Modifier Drugs: Heparin Therapy

In the past 2 years, Maciej, a 56-year-old lawyer, has had three episodes of DVT. All occurred without complications, and all were treated successfully with anticoagulant therapy and bed rest. He has now arrived at the emergency department because of increased pain and swelling in his left calf that has lasted for the past 3 days. Initially, he is given 5 000 units subcut of heparin. On admission to the hospital for anticoagulant therapy, he is started on a continuous infusion of 25 000 units of heparin in 500 mL of 0.9% sodium chloride (prefilled bag).

1. What nursing actions should be implemented to ensure the accuracy and safety of the continuous heparin infusion?

2. What patient findings would indicate a therapeutic response to the heparin therapy? Maciej suddenly reports numbness and tingling in his lower extremities with accompanying changes in muscle strength and sensation, 12 hours after the initiation and continuation of heparin therapy.

3. What would be the most appropriate nursing actions to implement? DVT, deep vein thrombosis.

Critical Thinking Activities -Coagulation Modifiers Drugs

1. After a patient undergoes total hip replacement, the nurse reviews the new postoperative orders and notes an order for dalteparin sodium (Fragmin) 2 500 international units subcutaneously 6 hours after surgery, then 5 000 international units daily for 7 days. When assessing the patient before administering the drug, the nurse sees that the patient has an epidural catheter for administration of pain medication. What is the nurse's priority action regarding the administration of the dalteparin sodium?

2. A patient is going home from hospital and will be taking warfarin (Coumadin). While discussing his medications just before his discharge, the patient says, "I want to get back to taking my vitamins with ginkgo. They really help my memory." What is the priority as the nurse answers the patient's question?

3. A patient who has been receiving a heparin infusion for DVT has a new order for warfarin (Coumadin). When the nurse explains that the warfarin is another drug to prevent blood clot formation, the patient asks if it is safe to be taking "two blood thinners at the same time." What is the nurse's best response to this patient's question?