Question

John Smith, 68 year-old male, is diagnosed with heart failure. He is also an asthmatic and diabetic. He is usually on 2 liters of oxygen, but is now requiring 6 liters of oxygen by nasal cannula. John experiencing significant dysp upon exertion. You are caring for him and are responsible for nea interpreting his medication orders and subsequent nursing implications. Here are John's current vitals and medications: Vitals: HR: 58 BP: 168/90 RR: 24 Spo2: 90%, 6 Liters per Nasal Cannula Temp: 98.9 degrees F Medications: Metoprolol 25mg PO BID Lasix 40mg PO BID Lisinopril 20mg PO BID Prednisone 10mg PO Daily What medication (s) may be problematic ooncerning the patient's diabetes? The patient's creatinine is 2.5, what medications may need to be held? Why? What diet should the patient be on? What will you report to the physician? Why?

Answer 1

Heart failure is a condition in which the heart is not able to pump up blood and meet the actual blood requirement of the body.

1. The assessment of the patient include examination of breathing as the patient is asthmatic. The swelling of the legs and feet should be examined. As the patient is diabetic he usually experiences frequent urination which should be examined carefully. The patient required 6 litres oxygen and his physical activity should be assessed closely along with the sleeping habit.

2. The laboratory tests which should be focused carefully are

Renal function test- proper functioning of kidney should be monitored.

Complete blood count- the reduced RBC count can indicate heart failure.

Brain natriuretic peptide- the BNP level drops when treatment for heart failure is going on.

Blood glucose- the sugar levels must be controlled in the patient.

Lung function test- it is also important as he is asthmatic.

Lipid panel- lipid panel is a blood test which measures fatty substances used in the body.

3. Lasix is used to reduce swelling and the treat high BP. In the above case, the effectiveness of Lasix can be evaluated by observing the swelling in John body. Furosemide may reduce blood sugar control for people with diabetes.

Lowering the amount of sodium you eat to no more than 1,500 milligrams per day is one of the most important ways to manage heart failure.Fiber helps move food along your digestive tract, controls blood sugar levels, and may reduce the level of cholesterol in your blood.  Limit the number of calories you have each day.

Lisinopril should be withheld as he is diabetic.