Heart Failure Case Study

Answer the questions based on the following scenario

Mrs. G is an 83 y/o female admitted with worsening heart failure. She was getting increasingly fatigued and “gets winded just walking out to the mailbox to get her mail.   She also is crying because her rings do not fit and she is waking up at night with trouble breathing. Sometimes she forgets to take her medicine and she has had a poor appetite, and sometimes eats a little toast and has some milk for dinner.

Admission labs are

  • Sodium 138
  • Chloride 102
  • Potassium 2.9
  • Glucose 93

She has an EKG that shows Normal Sinus Rhythm at 72

The doctor has reordered her home meds listed below

  • Digoxin 0.25 mg po every morning
  • Lasix 40 mg po every morning
  • Metoprolol XL 25 mg po daily

The nurse assesses the patient:

  • Dyspnea with exertion and needs HOB elevated to be able to breathe while in the bed.
  • Has 2 plus pitting edema in feet, ankles, and lower legs
  • Says not eating because feels full all the time
  • VS T 97.7, Apical heart rate is 64, RR is 22, Pulse Oximetry is 92% on room air.

What additional assessment should the nurse complete on this patient before calling the doctor with assessment and lab findings?

Identify a priority nursing problem and at least 3 interventions the nurse should institute at this time

The nurse is concerned about the lab work and the current medication list.

Explain what each medication is for in the treatment of heart failure.

Explain which medication the nurse is concerned about giving and why

Explain what lab work is concerning and what the nurse is going to ask for from the doctor.

What drug class might have been used in place of digoxin?

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