Question

In: Nursing

Mr. Morgan is a client who has been coming to the clinic for several years for...

Mr. Morgan is a client who has been coming to the clinic for several years for management of coronary artery disease (CAD) and hypertension (HTN). A cardiac catherization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a chest x-ray (CXR) showed cardiomegaly, and a 12 lead electrocardiogram (ECG) showed sinus tachycardia. You review his morning labs and initial assessment.

Chemistry

Sodium

142 mEq/L

Chloride

95 mEq/L

Potassium

3.9 mEq/L

Creatinine

0.8 mg/dL

Glucose

82 mg/dL

BUN

19 mg/dL

CBC

WBC

5400/mm3

Hgb

13g/dL

Hct

41%

Platelets

229,999/mm3

Initial Assessment

Complains of increased fatigue and shortness of breath, especially with activity, and “waking up gasping for breath” at night, for the past 2 days.

Vital Signs

Temperature

97.9 F

Blood pressure

142/83 mmHg

Heart rate

105 beats/min

Resp rate

18 breaths/min


1. As you review these results, which ones are of possible concern, and why? (5 points)

2. Knowing his history and seeing his condition this morning, what further questions are you going to ask Mr. Morgan and his daughter? (5 points)

Mr. Morgan tells you he becomes exhausted and has shortness of breath climbing the stairs to his bedroom and has to lie down and rest (“Put my feet up”) at least an hour twice a day. He has been sleeping on two pillows for the past 2 weeks. He has not salted his food since the physician told his not to because of his high blood pressure, but he admits having had ham and a whole bag of salted peanuts 3 days ago. He denies having palpitations but has a constant, irritating nonproductive cough lately.

3. You think it’s likely that Mr. Morgan has heart failure (HF). From his history, what do you identify as probable causes for his HF? What risk factors does he have for heart failure? (5 points)

4. You are ready to do your physical assessment. For each potential assessment finding for HR, indicate whether the finding indicates left-sided (L) or right -sided heart failure (R). (5 points)

__1. Fatigue, weakness, especially with activity

__2. Jugular (neck vein distention)

__3. Dependent edema (legs and sacrum)

__4. Hacking cough, worse at night

__5. Enlarged liver and spleen

__6. Exertional dyspnea

__7. Distended abdomen

__8. Weight gain

__9. S3/S4 gallop

__10. Crackles/wheezes in lungs

5. What diagnostic tests will be ordered and provide a rationale for the test? (5 points)

Chart view/Medication Orders

Enalapril

10 mg PO twice a day

Furosemide

20 mg PO every morning

Carvedilol

6.25 mg PO twice a day

Digoxin

0.5 mg now, then 0.125 mg PO daily

Potassium chloride

10 mEq tablet PO once a day

The physician confirms your suspicions and indicates that Mr. Morgan is experiencing symptoms of early left-sided heart failure. Medication orders are listed above.

6. For each medication listed, identify its class, and describe its purpose for the treatment of HF. (10 points)

7. As you remove the digoxin tablet from the automated medication dispensing machine, you note that the dosage on the table label is 250mcg. What will you do? How much will be given? (5 points)

8. Based on the medication orders, which blood test or tests should be monitored carefully? Explain your answer. (7 points)

9. When you give him his medications, he looks at the potassium tablet, wrinkle his nose, and tells you he “hates those horse pills.” He tells you a friend of his said he could eat bananas instead. He says he would rather eat a banana every day than take one of those pills. How will you respond? (3 points)

10. This is Mr. Morgan’s first episode of significant HF. Before he leaves the clinic, you want to teach him about lifestyle modifications he can make and monitoring techniques he can use to prevent or minimize future problems or hospital admissions. List five suggestions you might make and the rationale for each. (10 points)

11. You tell Mr. Morgan the combination of high sodium foods he had during the past several days might have contributed to his present episode of HF. He looks surprised and says, “But I didn’t add any salt to them!” What specific diet teaching can be done with Mr. Morgan? (5 points)

12. You also include teaching about digoxin toxicity. When teaching Mrs. Morgan about the signs and symptoms of digoxin toxicity, which should be included? (Select all that apply.) (3 points)

  1. Dizziness when standing up
  2. Visual changes
  3. Loss of appetite or nausea
  4. Increased urine output
  5. Diarrhea

13. What is the action of digoxin? Digoxin: (2 points)

        a. causes systemic vasodilation.

        b. promotes the excretion of sodium and water in the renal tubules.

        c. increases cardiac contractility and cardiac output.

        d. blocks sympathetic nervous system stimulation to the heart.

14. Which findings would indicate an increased possibility of digoxin toxicity? Explain your answer. (5 points)

          a. Serum potassium level of 2.2mEq/L

            b. Serum sodium level of 139mEq/L

            c. Apical heart rate of 64 beats/minute

            d. Digoxin level of 1.6ng/mL

15. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril, work to reduce heart failure? (Select all that apply) ACE inhibitors: (5 points)

            a. prevent the conversion of angiotensin I to angiotensin II

            b. cause systemic vasodilation.

            c. promote the excretion of sodium and water in the renal tubules.

            d. reduce preload and afterload.

            e. increase cardiac contractility.

            f. block sympathetic nervous system stimulation to the heart.

16. What patient teaching should be included for a patient on an ACE inhibitor? (5 points)

17. What are three parameters you would assess before/after administration of Furosemide? (3 points)

18. What patient teaching should be included for a client on Furosemide? (5 points)

19. What is the purpose of the beta blocker carvedilol? It is given to: (2 points)

            a. increase the contractility of the heart.

            b. cause peripheral vasodilation.

            c. increase urine output.

            d. reduce cardiac stimulation by catecholamines.

20. What patient teaching should be included for a client on a beta blocker? (5 points)

Solutions

Expert Solution

1, patient chest X ray showing cardiomegaly that need more attention. if heart size increases patient will be under risk for heart failure. so that patient is having associated symptoms of shortness of breath, dizziness and irregular heart beat, hypertension etc.
2, Ask patient when is his last visit to cardiologist.
Ask patient whether he is adhere with following medications.
Ask patient about family hisootry of cardiomegaly
colec the patient diet history, exercise and various activity level.
3, Patient history of coronary aretey disease, hypertension most probable cause of heart failure. Patient 50% stensis in the coronary artery shows a heart valve defects that is the main cause for getting risk of heart failure.
4, It is showing left-sided heart failure because patient having most symptoms of left-sided heart failure like awakening at night due to gasping of breath, shortness of breath during activity, dizziness, sinus tachycardia, cardiomegaly, high blood pressure, etc.
1, Fatigue, weakness, especially with activities(left-sided heart failure)
2, Jugular(neck vein distension)-right sided heart failure
3, Dependent edema(legs and sacrum)- left-sided heart failure
4, Hacking cough, worse at night -left-sided heart failure
5, enlarged liver and spleen -right-sided heart failure
6, Exertional dyspnea -right-sided heart failure
7, distended abdomen-right sided heart failure
8, Weight gain- left-sided heart failure
9, s3/s4 gallop- left-sided heart failure
10, crackles/wheezes in lungs -left-sided heart failure.


Related Solutions

You have been auditing the same client for several years and the client has asked you...
You have been auditing the same client for several years and the client has asked you to try to save some money this year on your audit fees. The client assures him that none of his procedures or personnel have changed in the last year. Based on this information, you decide that it is OK to set aside several audit procedures since in the past you were fine. Do you think that you have violated any provision of the code...
Mr. V is a 55-year-old alcoholic who checked into a clinic, complaining that he has been...
Mr. V is a 55-year-old alcoholic who checked into a clinic, complaining that he has been experiencing a persistent cough and feeling more fatigued, nauseous, and irritable. In addition, he is experiencing more frequent memory lapses. His stomach is distended, but on palpation, his liver is small in size and firm, indicating cirrhosis. Lab tests indicate a decrease in hemoglobin, albumin, levels with elevated serum bilirubin and ammonia levels. QUESTION: Our liver has numerous important bodily functions. Explain the importance...
Mr. V is a 55-year-old alcoholic who checked into a clinic, complaining that he has been...
Mr. V is a 55-year-old alcoholic who checked into a clinic, complaining that he has been experiencing a persistent cough and feeling more fatigued, nauseous, and irritable. In addition, he is experiencing more frequent memory lapses. His stomach is distended, but on palpation, his liver is small in size and firm, indicating cirrhosis. Lab tests indicate a decrease in hemoglobin, albumin, and prothrombin levels with elevated serum bilirubin and ammonia levels. 1. Describe the various stages through which Mr. V’s...
Mr. V is a 55-year-old alcoholic who checked into a clinic, complaining that he has been...
Mr. V is a 55-year-old alcoholic who checked into a clinic, complaining that he has been experiencing a persistent cough and feeling more fatigued, nauseous, and irritable. In addition, he is experiencing more frequent memory lapses. His stomach is distended, but on palpation, his liver is small in size and firm, indicating cirrhosis. Lab tests indicate a decrease in hemoglobin, albumin, levels with elevated serum bilirubin and ammonia levels. a) Provide a specific rationale for each of Mr. V’s manifestations...
Wade Corporation has been your audit client for several years. At the beginning of the current...
Wade Corporation has been your audit client for several years. At the beginning of the current year, the company changed its method of inventory valuation from average cost to last in, first out (LIFO). The change, which had been under consideration for some time, was in your opinion a logical and proper step for the company to take. What effect, if any, will this situation have on your audit report for the current year?
Your firm has a client who has been a management accountant for many years and is...
Your firm has a client who has been a management accountant for many years and is now also teaching part-time at TAFE and has recently acquired a rental property. We prepared his Tax Return, sent it out for signature. He has sent the Tax Return back to us unsigned, saying that we had made an error in claiming a tax deduction for the interest and expenses for the first four months that he owned the rental property, as it was...
Mr. Johnson is a 63-year-old client who has been admitted to the emergency department following traffic...
Mr. Johnson is a 63-year-old client who has been admitted to the emergency department following traffic accident. He is exhibiting manifestations of an increased heart rate, increased cardiac output. His Accu-Chek shows an elevated blood glucose level. His respiratory rate is increased, and he has audible wheezes. During a neurological check, he exhibits pupil dilation. 1. Compare and contrast the sympathetic nervous system with that of the parasympathetic nervous system. 2. Discuss the difference between the efferent neurons and afferent...
A patient who has been on a high protriptyline HCl imipramine for several years is now...
A patient who has been on a high protriptyline HCl imipramine for several years is now discontinuing the drug. To avoid discontinuation symptoms, her prescriber has given the following taper instruction: “Decrease by 10 mg/day each week until discontinued”. The patient’s current dosage is 60 mg/day. How many 10-mg tablets will be required for the patient to complete the taper? (Will thumbs up)
Kathy is a 50-year-old female who has been a jogger for several years. She has recently...
Kathy is a 50-year-old female who has been a jogger for several years. She has recently been diagnosed with osteoarthritis. She has been taking ibuprofen for 3 months but states that “it does not help” and hurts her stomach. The health care provider prescribes celecoxib (Celebrex) 100 mg orally twice a day. a) Kathy expresses concern about all the recent news about heart problems and celecoxib (Celebrex). What information should be included in a teaching plan to help her understand...
You are caring for an adolescent in an outpatient clinic who has been diagnosed with a...
You are caring for an adolescent in an outpatient clinic who has been diagnosed with a sexually transmitted infection (STI). After reading your assigned readings on STIs, develop a plan of care for this client with the NANDA-I nursing diagnosis of Deficient knowledge.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT