Question

I.W., aged 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d. His medical history includes moderate prostatic hypertrophy for 5 years, adult-onset diabetes mellitus for 10 years, hypertension for 10 years, and degenerative joint disease for 5 years. His medication history includes hydrochlorothiazide (HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d, controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d, and indomethacin (Indocin) 25 to 50 mg three times a day as needed for pain. While reviewing his medical records, you see that his last physical examination revealed a blood pressure of 160/95 mm Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral pulses, mild edema bilaterally in his feet, a prominent S3 and S4, neck vein distention, and an enlarged liver.

Diagnosis: Heart Failure Class II

Answer the following questions. Include two references, cited in APA style.

List specific goals of treatment for I.W. What drug(s) would you prescribe? Why?

What are the parameters for monitoring the success of your selected therapy?

Discuss specific patient education based on the prescribed therapy. Describe one or two drug–drug or drug–food interactions for the selected agent(s).

List one or two adverse reactions for the selected agent(s) that would cause you to change therapy.

What would be the choice for the second-line therapy?

What over-the-counter or alternative medications would be appropriate for this patient?

What dietary and lifestyle changes should be recommended for I.W.?

Answer 1

Difficulty in breathing (Dyspnea) may occurs due to sveral reason.Pulmonary edema is one of them which is given above.

1-what is pulmonary edema?

Pulmonary edema is a condition caused by excess fluid accumulation in the air sacs(alveioli) of the lungs which makes it difficult to breath.In most cases pulmonary edema causes heart problems.

• Edema means swelling.It occurs when fluid from inside blood vessels seeps out side the blood vessels into the surrounding tissue causes swelling.
• This can happen either because too moch pressure in the blood vessels or not enough protein in the blood stream to hold into the fluid in plasma.
• Pulmonary edema is the term used when edema happens into the lungs.The immediet area out side of the small blood vessels in the lungs is occupied by the alveioli.
• This can cause problems with the exchange of gas,resulting in breathing difficulty and poor oxygenation of blood.
• Pulmonary edema can cause by many different factor .It can be related to heart failure,called cardiogenic pulmonary edema.
• RISK FACTOR:
• BREATHLESSNESS
• FATIGUE
• TACHYPNEA
• DIZZINESS
• WEAKNESS
• HYPOXIA
• ALCOHOL INTAKE
• SMOKING
• KIDNEY FAILURE
• ASPIRIN OVER DOSE

TREATMENT:-Most cases of cardiac pulmonary edema are treated by using diuretics (water pills) along with other medications for heart failure. In some situations, appropriate treatment can be achieved as an outpatient by taking oral medications. If the pulmonary edema is more severe or it is not responsive to oral medications, then hospitalization and the use of intravenous diuretic medications may be necessary.

*Oxygen supplementation is necessary if the measured oxygen level in the blood is too low. In serious conditions, such as ARDS, placing a patient on a mechanical breathing machine is necessary to support their breathing while other measures are taken to treat pulmonary edema and its underlying cause.

• LIFE STYLE MODIFICATION:-Life style modification include stop smoking and alcohol consumption to prevent cardiac and pulmonary diseases.
• restricted visit to polluted area.
• Avoid oily and spicy food.
• Take medication regularly.
• Keep in touch with your doctor.