Question

.   

Mrs. E., a 70-year-old Hispanic woman, was admitted to the medical unit with complaints of increasing dyspnea on exertion.

Subjective Data

·     Had a severe MI at 58 years of age

·     Has experienced increasing dyspnea on exertion during the last 2 years

·     Recently had a respiratory tract infection, frequent cough, and edema in legs 2 weeks ago

·     Cannot walk two blocks without getting short of breath

·     Has to sleep with head elevated on three pillows

·     Does not always remember to take medication

Objective Data

Physical Examination

·     In respiratory distress, use of accessory muscles, respiratory rate 36 breaths/min

·     Heart murmur

·     Moist crackles in both lungs

·     Cyanotic lips and extremities

·     Skin cool and diaphoretic

Diagnostic Studies

·     Chest x-ray results: cardiomegaly with right and left ventricular hypertrophy; fluid in lower lung fields

Collaborative Care

·     Digoxin 0.25 mg PO qd

·     Furosemide (Lasix) 40 mg IV bid

·     Potassium 40 mEq PO bid

·     Enalapril (Vasotec) 5 mg PO qd

·     2 g sodium diet

·     Oxygen 6 L/min

·     Daily weights

·     Daily 12-lead ECG, cardiac enzymes q8hr x 3

Explain the rationale for each of the medical orders prescribed for Mrs. E.

Answer 1

Looking at the scenario Mrs E is suffering from CARDIAC FAILURE.

Coming to your Q,

1) DIGOXIN - it is cardiac glycoside which acts on heart and increases HEART FORCE OF CONTRACTION

2) FUROSEMIDE - it is adiuretic drugs which causes INCREASE URINE FORMATION and so DECREASES INTRA-VASCULAR BLOOD VOLUME which in results DECREASES LOAD ON HEART.

3) POTASSIUM SUPPLEMENTS - Furosemide used can cause hypokaelemkia which can cause arrhythmias so to compensate that we give potassium.

4) ENALAPRIL - It is ACE inhibitors which causes VASODILATATION whic results into DECREASED AFTER LOAD TO HEART.

5) LOW SODIUM DIET - SODIUM RETAINS water which will put heart into extra load - so fluid and salt are restricted

6) oXYGEN SUPPORT - as patient has respiratory distress due to cardiac failure so instead of atmospheric air which has 23% oxygen better to give 100%oxygen

7) Daily weight - as wewant fluid restriction, weight will keep us to keep watch on it

8) cardiac enzyme and ECG for monitoring of MI.