Question

Your patient is an active 80-year-old woman with heart failure and chronic atrial fibrillation. You are taking an angiotensin-converting enzyme inhibitor, a beta-blocker, a diuretic, and digoxin. During her evaluation, she tells him that she felt very dizzy this morning.

How would you approach your evaluation and why?

Identify some of the key evaluation factors.

What nursing interventions are necessary?

How would you change your evaluation and interventions if your patient also had chronic obstructive pulmonary disease and kidney failure?

Answer 1

1. We can evaluate this situation as, possible hypotension which causes dizzy because patient is on medications such as ACE inhibitor, beta blocker, diuretic and digoxin. All these medications can cause dizzy. Check the vital signs first. If hypotension noted, inform physician and advise the patient to sit or lie down when dizzy and get up slowly to give blood vessels time to adjust.
2. If patient is vitally stable and no hypotension noted, check for the neurological status of the patient since the patient is 80 years old and not on any anticoagulants. The risk for stroke is high in patient with chronic atrial fibrillation and heart failure not on any anticoagulants.
3. If any neurological deficit (stroke) found, treat it. consider CHA2DS2-VASc score.
4. If the patient also had COPD and renal failure, do arterial blood gas analysis to rule out possible metabolic acidosis and stop the ACE inhibitor which causes chronic cough and uremia.