Question

What specific assessment findings indicate that an older adult patient being treated for CHF is not responding to digoxin, furosemide, and vasodilator therapy? How would you differentiate between expected, adverse, and toxic side effects?

Answer 1

Answer

Assessment in administering furosemide

· Assess fluid status.

· Monitor daily weight, intake and output ratios,

· Amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.

· Monitor BP and pulse before and during administration.

Before taking furosemide, tell your doctor if you also use digoxin. You may need dose adjustments or special tests in order to safely take both medications together. Furosemide and digoxin are often used together but may require more frequent evaluation of your digoxin, potassium, and magnesium levels.

Assessment in administering digoxin

· Monitor intake and output ratios and daily weights.

· Assess for peripheral edema, and auscultate lungs for rales/crackles throughout therapy. Before administering initial loading dose, determine whether patient has taken any digoxin in the preceding 2–3 wk.

Assessment in administering Vasodilators

Prior to administration:

■ Obtain a complete health history including allergies, drug history, possible drug interactions, and especially impaired cardiac/cerebral circulation.

■ Obtain an ECG and vital signs.

■ Auscultate heart and chest sounds.

■ Assess neurological status and level of consciousness.

■ Obtain blood and urine specimens for laboratory analysis

Side effects of Lasix include:

· increased urination,

· thirst,

· muscle cramps,

· itching or rash,

· weakness,

· dizziness,

· spinning sensation,

· diarrhea,

Early sign of digoxin toxicity

· Some early warning signs of overdose are confusion, loss of appetite, nausea, vomiting, diarrhea, or vision problems. Other signs of overdose are changes in the rate or rhythm of the heartbeat (becoming irregular or slow), palpitations (feeling of pounding in the chest), or fainting.

Side Effects Associated with Using Digoxin

• Dizziness.
• Mental disturbances.
• Diarrhea.
• Headache.
• Nausea.
• Vomiting.
• Red, bumpy rash.

Side effects associated with vasodilators

• Rapid heartbeat (tachycardia)
• Heart palpitations.
• Fluid retention (edema)
• Nausea.
• Vomiting.
• Flushing.
• Headache.
• Excessive hair growth.

The use of diuretics is common in patients with heart failure (HF), to relieve the congestive symptoms of HF. Although they are widely used, there are limited data on their ability to modulate HF-related morbidity and mortality.

More recently, several large-scale multicenter trials have documented improved survival in patients with heart failure who received vasodilating agents. These studies, in conjunction with hemodynamic and functional studies, argue strongly for the widespread use of vasodilator therapy, notably the angiotensin-converting enzyme inhibitors, for congestive heart failure and left ventricular systolic dysfunction.

Among NYHA class I and II patients, diuretic use was associated with a significant 25% increased risk of death.