Question

In: Nursing

Julia Cook is a 74-year-old retired secretary. Her medical history includes hypothyroidism, chronic renal insufficiency, and...

Julia Cook is a 74-year-old retired secretary. Her medical history includes hypothyroidism, chronic renal insufficiency, and hypertension. She suffered a myocardial infarction due to coronary artery disease 5 years ago. She was diagnosed with heart failure 1 year ago and has been managed with a diuretic and an ACE inhibitor. Six months ago, she developed an arrhythmia and was placed on quinidine. Over the past 2 months, her heart failure symptoms have been increasing in severity, with dyspnea and ankle edema occurring at rest or with minimal exertion. Digoxin is now being added to her heart failure treatment regimen.

a. The nurse is teaching Ms. Cook about the digoxin. What should the nurse teach Ms. Cook regarding digoxin toxicity?
b. Describe the factors that increase Ms. Cook’s risk for digoxin toxicity.
c. Ms. Cook’s symptoms continue to increase over the next month, and she is hospitalized for treatment of acute heart failure. She is given IV nesiritide along with an IV loop diuretic and digoxin. Discuss some of the nursing considerations related to the administration of the nesiritide.

Expert Solution

a.

Digoxin toxicity may be due to unintentional or accidental overdose, suicidal, homicidal or any interaction due to drug or ingestion of plant.This affects cardiac rate and rhythm and produce various dysthymias.

Symptoms can be seen related to Central nervous system, visual, gastrointestinal system, cardiac system with common symptoms like nausea, vomiting and drowsiness.

Central Nervous system

Lethargy
Neuralgia
Head ache
Hallucinations
Seizures
Confusion etc

Visual effects includes

Visual aberration
Yellow - green distortion
Snowy vision
Photophobia
Decreased visual acuity
Yellow halos

GI symptoms are

Anorexia
Weight loss
Abdominal pain
Diarrhea

Cardiac symptoms like

Palpitations
Shortness of breath or dyspnea
Syncope
Swelling of lower extremities
Bradycardia
Hypotension

b.

Ms Cook has risk for developing digoxin toxicity as she is on diuretic and quinidine.

Both these drugs have interaction with digoxin and may increase serum digoxin level, and later toxicity.

c.

Nesiritide is used to treat heart failure.

Continuously monitor patients heart rate, blood pressure and ECG while administering Nesiritide.
If Hypotension develops immediately stop or reduce the dose.
Serum creatine level may increase, so check before after and during administration of nesiritide.
Nesiritide cause severe hypersensitivity.

Nightingale answered 2 years ago

ohn Smith is a 64-year-old male. His past medical history includes BPH, HTN, chronic back pain,...

ohn Smith is a 64-year-old male. His past medical history includes BPH, HTN, chronic back pain, COPD, seasonal allergies, Erectile dysfunction, and intermittent UTI’s. Mr. Smith has completed school through 8th grade but then ultimately became a laborer until his retirement. His wife accompanies him to meetings with doctors to assist and learn about the medications as well. Mr. Smith is very independent however and does not want to rely on his wife. Each student will prepare an educational pamphlet...

Scenario: A 74-year-old male, retired accountant, with a long-standing history of hypertension and atherosclerosis, begins to...

Scenario: A 74-year-old male, retired accountant, with a long-standing history of hypertension and atherosclerosis, begins to exhibit some personality changes, deterioration in grooming, trouble understanding news events, and difficulty managing personal finances. He also stopped attending social events and dropped out of his chess club. His wife of 50 years becomes concerned and schedules an appointment with his healthcare provider, who diagnoses him with Vascular Dementia, Alzheimer’s type. Arrangements have been made for a visiting RN to come to the...

Philip is a 65-year-old retired salesman with a 20-year history of heart disease that includes 2...

Philip is a 65-year-old retired salesman with a 20-year history of heart disease that includes 2 myocardial infarctions, each followed by a bypass operation. The most recent bypass was last year. He has decided to begin an exercise program, but is experiencing shortness of breath. His physician conducted an exercise stress test using the Bruce protocol. He had to terminate the test after 5 minutes because of shortness of breath. An echocardiogram revealed a 30% ejection fraction. He was diagnosed...

74-year-old male, retired accountant, with a long-standing history of hypertension and atherosclerosis, begins to exhibit some...

74-year-old male, retired accountant, with a long-standing history of hypertension and atherosclerosis, begins to exhibit some personality changes, deterioration in grooming, trouble understanding news events, and difficulty managing personal finances. He also stopped attending social events and dropped out of his chess club. His wife of 50 years becomes concerned and schedules an appointment with his healthcare provider, who diagnoses him with Vascular Dementia, Alzheimer’s type. Arrangements have been made for a visiting RN to come to the house once...

Brenda, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to...

Brenda, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting,...

Emma, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to...

Emma, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting,...

Samantha, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to...

Samantha, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting,...

Homeostatic Case Study Patient: Mr. Kaunda70-year-old man with respiratory problems History: A 70-year-old man with chronic renal failure...

Homeostatic Case Study Patient: Mr. Kaunda70-year-old man with respiratory problems History: A 70-year-old man with chronic renal failure was in the hospital in serious condition recovering from a heart attack. He had just undergone "coronary angioplasty" to redilate his left coronary artery, and was thus on an "npo" diet (i.e. he was not allowed to have food or drink by mouth). He received fluid through an intravenous (IV) line. Late one night, a new nurse who really did not understand the concept...

A 64-year-old retired postal worker with a medical history of extensive facial reconstruction for squamous cell...

A 64-year-old retired postal worker with a medical history of extensive facial reconstruction for squamous cell carcinoma of the head and neck and a 10 year history of smoking, presented with progressive shortness of breath, productive cough, purulent sputum, and a fever of 39 C 2 days prior to admission to the hospital On physical examination at the hospital, he had a temperature of 37.3 C, respiratory rate of 18/min, pulse rate of 103 beats/min, blood pressure of 154/107 mm...

Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman...

Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In...