A 73-year-old woman is admitted to the telemetry unit

A 73-year-old woman is admitted to the telemetry unit with right-sided heart failure, type 2 diabetes mellitus, hypertension, and chronic obstructive pulmonary disease (COPD). When the patient arrives to the unit, you observe that her color is pale, she is becoming increasingly dyspneic, and she reports a new onset of chest discomfort. The patient's husband is very concerned because he thinks his wife is slightly disoriented. Her oxygen saturation levels are 88% on oxygen 2 liters per nasal cannula.

1. Using clinical judgment, what should you assess first?
2. The patient's health care provider prescribes an initial dose of furosemide (Lasix) 40 mg IVP. What assessments will you perform to determine if the drug was effective?

3. The patient's husband remains very anxious and asks to stay at her bedside. What will you tell him about her condition at this time? Should the patient's husband be present during her emergency treatment? Why or why not?

4. After two doses of furosemide, the patient's condition improves. What data will you document in the electronic medical record (EMR)?

HOMEWORK

Name 3 of each of the following Cardiovascular medication and their side effects

ACE inhibitors

Beta Blockers

Diuretics

Inotropic Agents

Nitrates

Calcium Channel Blockers

Sample Paper

Case study

1. Using clinical judgement, what should you assess first

Based on clinical judgement, I will first assess any presence of chronic obstructive pulmonary disease, as it is the major cause of morbidity and mortality rates globally.

2. The patient's health care provider prescribes an initial dose of furosemide (Lasix) 40 mg IVP. What assessments will you perform to determine if the drug was effective?

I will conduct assessment on the onset of diuresis. This is to validate if there is urine increase within an hour. I will also assess if peak effects are seen within 1 to 2 hours.

3. The patient's husband remains very anxious and asks to stay at her bedside. What will you tell him about her condition at this time? Should the patient's husband be present during her emergency treatment? Why or why not?

I will evaluate the husband’s level of anxiety to determine clinical interventions that could help reduce his anxiety and make him feel at ease (Lacerda et al., 2017). Once the husband is relaxed, I will explain that his wife’s condition can be managed and controlled through constant medical monitoring and medication to examine any health complications that might arise and risk her health. The husband should not be around during the emergency treatment to avoid bridging off the patient’s confidentiality unless she demands his presence. Another reason could also be to protect the husband from developing higher levels of stress and anxiety due to the medical expenses that might incur during the emergency treatment process.

4. After two doses of furosemide, the patient's condition improves. What data will you document in the electronic medical record (EMR)?

I will document the patient’s medical history at the point when she was admitted. These include the physical signs and symptoms observed by the facility and those reported by the patient. I will also record the treatment progress in the EMR.

Homework

Name of each of the cardiovascular medications below and their side effects:

ACE inhibitors. Some of these inhibitors are enalapril, lisinopril, and ramipril. Some of the side effects are dry cough, fatigue, dizziness, and increased potassium levels in the blood.

Beta blockers include carvedilol, bisoprolol, and metoprolol. The side effects are feeling tired and light-headed due to slow heart rates, difficulties in sleeping and nightmares, occasionally feeling sick.

Diuretics. There are three types of diuretics, thiazide, loop, and potassium sparing. The commonly used loop diuretics are bumetanide, furosemide and torsemide. The side effects include dizziness, headaches, and impotence.

Inotropic agents are classified into positive inotropes that strengthen the heartbeat and negative inotropes that weaken the heartbeat. Examples of inotropic agents are dobutamine, dopamine, and digoxin. The side effects include; the presence of headache, rash, and tremor.

Nitrates include nitrostat, nitromist and nitro-bid. The side effects include headache, nausea, and flushing.

Calcium channel blockers examples are nifedipine, diltiazem, and verapamil. The side effects include constipation, frequent headaches, and swelling in the feet and lower legs.

 

Reference

Lacerda, M. S., Cirelli, M. A., Barros, A. L. B. L. D., & Lopes, J. D. L. (2017). Anxiety, stress and depression in family members of patients with heart failure. Revista da Escola de Enfermagem da USP, 51. https://www.scielo.br/j/reeusp/a/j9ZNWq5nqK6CLdCyGDJC46r/?format=pdf&lang=en