Topics: Angiotensin II receptor antagonist, Hypertension, Angiotensin-converting enzyme Pages: 3 (868 words) Published: April 18, 2014
Cardiovascular Disorders
Case Study 1 Heart Failure
Diffi culty: Beginning
Setting: Emergency department, hospital
Index Words: heart failure (HF), cardiomyopathy, volume overload, quality of life Scenario
M.G., a “frequent fl ier,” 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 she is strictly following the fl uid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. 1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? [c] She was not instructed when to call with early weight gain, thus leading to her current ED visit. Patients need to be instructed when to call their provider after being discharged from the hospital for exacerbated HF. Complete self-management patient education is considered a standard of care and is mandated by The Joint Commission when providing care to hospitalized patients. The goal of the discharge treatment plan is to minimize symptoms and prevent readmission.

You chart the medications M.G. brought with her: enalapril (Vasotec) 5 mg bid, digoxin 0.125 mg/day, rosiglitazone 4 mg, furosemide 40 mg/day, and potassium chloride 20 mEq/day. The admitting provider orders all the medications but changes the furosemide to 80 mg IV push (IVP) now, then 40 mg/ day IVP.

PART ONE Medical-Surgical Cases
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. 2
PART ONE Medical-Surgical Cases
2. What is the rationale for changing the method of administering furosemide? [c] M.G. is fl uid overloaded and needs to decrease fl uid volume in a short period. IV administration is delivered directly into the vascular...
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