Question

You are a primary care nurse in a heart failure clinic. Mr. G presents in the clinic with a three-pound weight gain in the past two days. Upon assessment, he has +2 pitting edema in bilateral lower extremities. When you ask him about his regular Lasix regimen, he shows you a plastic bag full of pills and states that he has so many pills prescribed, he just takes what he thinks he needs when he feels like he needs it. Included in the bag are Cardizem, Toprol XL, glipizide, gabapentin, Lasix, multiple vitamins, ginseng supplements, fish oil supplements, and cinnamon supplements. Where do you start? How can you coordinate a multidisciplinary approach in caring for this patient? What patient education is necessary? How can you assist Mr. G in keeping his medications straight?

Answer 1

Weight gain shows that the patient is not under the control of the disease. The key role of nurses is to assess Mr.G and to manage him properly through the regimen. I start from Initial assessment which includes

• Collect the past medical history and treatment regimen.
• Assess the signs and symptoms of the patient.
• Assess the severity of dyspnea such as respiratory rate, saturation level, exertion on breathing.
• Assess the hemodynamic status and the systolic and diastolic pressure.
• Assess the heart rate and 12 lead ECG.
• Assess the blood sugar level. His medication pill shows that he is diabetic.
• Assess the fluid and electrolyte balance.
• Assess for breath sounds, heart sounds, and check jugular venous pressure.
• Check for peripheral edema.
• Assess the level of consciousness.

According to the American Heart Association, a multidisciplinary approach is essential in managing of heart failure patient. A team of physician, cardiologist, Diabetologist, nurse, dietician, Nephrologist should be collaboratively approached in caring for the patient. Mr.G should be kept under fat-free, low salt, diabetic diet. The nursing intervention should be based on the underlying cause and the laboratory findings. Record intake and output and maintain positive fluid balance. Maintain the blood sugar level to avoid secondary complications. Administer oxygen if necessary based on the saturation level. Check for weight. Report to the physician, the lab values, and other changes in order to alter the medications.

Patient's Education:

• Educate the patient about his health status and self-care management.
• Educate about low sodium diet and avoidance of excessive intake of fluids.
• Educate about the diabetic diet.
• Explain the importance of follow-up of treatment.
• Educate about the lifestyle modification such as to avoid of workload and stress.
• Educate about the nutritional therapy.
• Avoid alcohol consumption and smoking.
• Explain about the medication chart and its importance.
• Educate to avoid the risk of complications.

Assist in medication:

Explain the treatment to the patient and family members.

Diuretics such as Lasix to eliminate the excess fluid in the body and to prevent edema.

Toprol XL is a beta-blocker to regulate the blood pressure and circulation. Initially, it may worsen the condition and then improves after several weeks.

Glipizide to control the blood sugar level.

Gabapentin acts as an anxiolytic agent to control the anxiety level of the patient.

Cardizem is a calcium channel blockers to reduce the systemic vascular resistance.

Multiple vitamins to improve the health and to protect the arteries.

Ginseng supplements to protect the tissues from damage.

Fish oil supplement reduces the risk of heart attack.

Cinnamon helps to reduce the risk and treat the heart problems.

Give the weekly or monthly chart, so that Mr.G take the medication with correct dosage at right time. Advise the family members to remind him and to check for regular intake of medication. Advise taking one set of medications to keep with, so that he can't miss the dose if he is outside. Educate and encourage him to use digital apps that remind on medication every time with correct name and dosage. It also helps to monitor his daily weight, blood sugar, and BP level. So he keeps track of his health condition and reports to the physician.