06 Dec M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF).
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 that 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.
What error in teaching most likely occurred when M.G. was discharged 10 days ago?
CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. Chart View 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
Which of these medications may have contributed to M.G.’s HF? Explain
After reviewing M.G.’s medications, the physician writes the following medication orders. Chart View Medication Orders Enalapril (Vasotec) 5mg PO bid Carvedilol (Coreg) 3.125mg PO twice daily Glipizide (Glucotrol) 10mg PO every morning Furosemide (Lasix) 80mg intravenous push (IVP) now, then 40mg/day IVP Potassium chloride (K-Dur) 20mEq/day PO
What is the rationale for changing the route of the furosemide (Lasix)?
You administer furosemide (Lasix) 80mg IVP. Identify three parameters you would use to monitor the effectiveness of this medication
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 level
e. Potassium level
f. Coagulation studies
What is the purpose of the beta blocker carvedilol? It is given to:
a. increases the contractility of the heart.
b. cause peripheral vasodilation.
c. increase urine output.
d. reduces cardiac stimulation from catecholamines
You assess M.G. for conditions that may be a contraindication to carvedilol. Which condition, if present, may cause serious problems if the patient takes this medication?
a. Angina
b. Asthma
c. Glaucoma
d. Hypertension
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