Download Complications of Heart Disease Case Study Answers

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Transcript
Answers to Case Study, Chapter 30, Management of Patients With Complications
From Heart Disease
Objective:
1
Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three
myocardial infarctions in the last ten years, he has decreased left ventricular function. Mr.
Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease.
Today he presents to the Emergency Department with fatigue, generalized weakness, and
feelings of “skipping” heartbeats. Upon arrival, he is placed on the cardiac monitor, his
vital signs are assessed, and an IV is inserted. He currently denies chest pain, but is
experiencing some shortness of breath, and is placed on 2 liters of oxygen via nasal
cannula.
Which of his medications might be contributing to his symptoms of generalized
weakness and heart irregularities?
One of the major side effects of Lasix is hypokalemia. Mr. Edwards’ symptoms of
fatigue, generalized weakness and cardiac irregularities are seen in the patient with
hypokalemia. Hypokalemia in patients with heart failure is also problematic as it
markedly weakens cardiac contractions.
What clinical manifestations should you assess for to correlate to his left-sided heart
failure?
In left-sided heart failure, the left ventricle does not completely empty, eventually leading
to a backup of blood into the pulmonary system. Clinical manifestations include dyspnea,
cough, pulmonary crackles, low oxygen saturation, and, ultimately, decreased cardiac
output.
How do his medications treat his congestive heart failure?
The Digoxin increases force of myocardial contractility and slows conduction through the
atrioventricular node. This improves contractility and leads to increased left ventricular
output. Capoten, an ACE-inhibitor, promotes vasodilation and diuresis by decreasing
preload and afterload. The vasodilation decreases resistance to left ventricular outflow.
ACE inhibitors also decrease secretion of aldosterone resulting in sodium and water
excretion. Coreg is a beta-blocker administered to patients with left-sided failure to slow
heart rate. Lasix is a diuretic that decreases preload.
How does the hypokalemia affect the effects of Digitalis?
Digitalis toxicity may occur secondary to hypokalemia, and increase chances of
dangerous dysrhythmias.