Reference no: EM133867607
Case Scenario
A patient had complaints of epigastric pain and burning sensation in the middle of her chest. She denied feeling short of breath at the time. The pain was not heavy, and she said it is relieved with antacids. The patient has acid reflux and has been taking Mylanta suspension OTC as needed for the past few days. She stopped taking Mylanta after getting constipated. She told her primary care provider about this over the phone, and she was given prescription for Nexium 40 mg po daily and was told to call him if the symptom persists or worsens. She has sustained previous inferior and anterior myocardial infarctions in the past and is on diuretics routinely. She also has past medical history of hypertension, myocardial infarction, and heart failure.
She presented in the emergency room a week later with gradually increasing fatigue and edema on bilateral lower extremities despite increasing diuretic therapy. She also complained of orthopnea, and chest tightness when supine. She stated her epigastric pain was relieved with the Nexium regimen given to her, and the orthopnea and chest tightness is new. She is being treated with furosemide 80 mg two times daily (increased from once a day 3 days ago), aspirin 150 mg once daily, isosorbide mononitrate SR 60 mg once daily, Digoxin 0.125 mg daily, and amlodipine 10 mg once daily. The patient also developed tachycardia while at the hospital, and carvedilol was ordered 10 mg twice a day po.
1. In giving diuretics, what lab values will you monitor the patient for? Why?
2. What should you do before giving Digoxin and Carvedilol? Why?
3. Did Mylanta cause Mrs. Jones to developed constipation? What are the three common types (ingredients) of antacid? Which one causes constipation, and which one causes diarrhea?
4. Using a concept map, provide a graphic representation of the relationships between all the symptoms presented, and the pharmacological agents that correspond to each. Include the diagnosis, the drug class, brand name, nursing considerations and adverse effects (if applicable). A concept map template is provided for you. Edit it to fit the case scenario as you see fit.