Question

Mrs. S, a 63-year-old patient who suffered a myocardial infarction last year, is in the cardiac rehabilitation center for follow up after suffering from fatigue and shortness of breath; she complains of a “fluttering” feeling with her heartbeat and she has an occasional productive cough. Mrs. S normally does not struggle with nighttime urination, but for the past month, she has to get up to use the bathroom 2-3 times per night. She has gained 5 pounds in the past week.

1. Mrs. S’s physician believes that she has developed congestive heart failure after having an MI last year. Which test would most likely be used to confirm the presence of CHF?

2. The nurse performs a physical assessment on Mrs. S and checks her respiratory rate while listening to her lung sounds. If Mrs. S has CHF, what signs would the nurse most likely notice when performing a respiratory assessment?

After diagnostic testing, Mrs. S is diagnosed with congestive heart failure. Her physician prescribes oral Lasix for her to take every day to help with some of her symptoms and assists her with starting a program through cardiac rehabilitation where she can exercise on a routine basis and continue to be monitored by health professionals.

3. What types of tests would this patient undergo that would diagnose heart failure?

4. How does Lasix help with congestive heart failure symptoms?

5. What information should the nurse include with teaching Mrs. S about taking a diuretic medication, such as Lasix?

6. In addition to regular exercise, what other types of lifestyle changes should Mrs. S implement to control her symptoms of heart failure?

Mrs. S has started taking Lasix and continues with cardiac rehabilitation. She lost the recent weight gained and is able to walk a little further than before when using the treadmill. She also does not get up as often during the night to use the bathroom when she takes her Lasix first thing in the morning. However, Mrs. S still complains of a fluttering feeling in her chest and her blood pressure readings have been elevated. Her last BP was 140/88 mm/Hg. The physician orders Captopril 50 mg po tid and has her come back to the clinic in 2 more weeks.

7. What type of drug is Captopril?

8. Why would this type of medication be prescribed for a patient with heart failure?

9. What information is most important for the nurse to give this patient when using this medication?

10. How would Mrs. S know if her medications are working to control her heart failure?

11. What is a primary nursing diagnosis for Mrs. S and why?

Answer 1

Myocardial infarction:

It is a type of cardiac condition, in such there is necrosis of heart muscle caused by an interruption to the blood supply to the heart, often as a result of Coronary thrombosis.

Congestive heart failure( CHF) :

Congestive heart failure is a groups of syndrome marked by weakness, edema, shortness of breath, due to the inability of the heart to circulate the blood adequately to the lungs and other tissues.

Respiratory assessment:

Abnormal lung sounds while Auscultation: moist crepitant takes , or coarsed crackles and wheezing are the signs of fluid retention due to CHF.

1. Test to confirm the presence of CHF:

Electrocardiogram ( ECG/EKG) and Chest x-ray are the two important tests used to diagnose CHF.

ECG is used to assess the electrical activity and the rhythm of the heart. Arrhythmia in CHF can be revealed by ECG.

Chest x-ray : shows the enlarged heart and fluid collection in the lugs, that is an important indication of CHF.

2. Respiratory assessment:

Abnormal breath sounds on Auscultation; Moist crepitant rales, or coarsed crackles and wheezing are the signs of fluid retention due to CHF.

3. Tests to confirm CHF:

* ECG: to detect arrhythmias and abnormal electrical activity.

* Chest X-ray : to detect fluid retention in the lungs and the enlagement of heart.

* Echo cardiogram: to detect abnormalities if the heart structure, muscles and valves

* Blood test:

* Stress test: to detect possible damage to the heart and extend of Coronary artery diseases

* Coronary angiography: to detect the blockage or other abnormalities of the Coronary vessels

Physical examination also can reveal the generalized and specific edema and fatigue , Shortness of breath etc.

4. Lasix and CHF

Lasix: is a brand of drug Furosemide, a diuretic used in the treatment of CHF and edema. This loop diuretic enable the kidney to increase urine outflow,thus reducing the fluid retention and edema in the body. pulmonary and cardiac congestion due to fluid accumulation ,also can be revealed by diurteics.

5. Patient teaching

* Instruct the patient to take the medications as per Doctor's order. adhere to medication regimen . don't take double dose at a time

* Drink enough water , when you are taking Lasix, otherwise the the symptoms such as light headedness, weakness etc especially while doing exercise.

* Avoid alcohol and other drug abuse

* Change the positions slowly to prevent orthostatic hypotension

* Report to healthcare providers in case of any allergic condition or weight gain and edema.

6. Life style changes to control cardiac failure symptoms

* Heart healthy diet , includes whole grain ,low fat and low calorie diet , include vegetables and fruits to the diet.

* avoid saturated fat and processed food,. Have freshly made food with no artificial sweeteners and salt.

* Strict medication adherence has to be followed.

* Avoid alcoholism and smoking completely

* Regular physical exercise as per Doctor's order

* Regular follow up

7. Captopril:

An ACE inhibitor ( Angiotensin converting Enzyme inhibitors ) used to treat hypertension and Congestive heart failure.

8. CHF and captopril

Captopril helps to dialate the blood vessels,thus decreasing blood pressure. Angiotensin used to narrow blood vessels, and captopril inhibits the Angiotensin production. Smooth blood flow through the dilated blood vessels decreases the pumping load of heart, improves the heart 's ability and blood flow to the kidney ,there by decreases the symptoms of CHF.

9. Information to the patient

* Avoid any workout in the sunlight, do not be overheated

* Avoid dehydration

* Avoid certain food that may interact with captopril such as salt substitute or potassium supplement

* Follow Doctor's instructions on medication and the food and fluid .

11. Nursing diagnosis: CHF

Decreased cardiac output related to alteration in rhythm ,rate and electrical conduction of heart as evidenced by dysarrythmias and respiratory crackles.