Scenario G.J. is an 82-year-old woman with a 50-year history

Scenario G.J. is an 82-year-old woman with a 50-year history of… ScenarioG.J. is an 82-year-old woman with a 50-year history of mitral valve disease stabilized on digoxin for 10 years. She took her medications on an empty stomach every morning. She recently moved into a nursing home. The staff change her dose schedule to afternoons to correlate with snack time.G.J. began to develop progressive weakness, dyspnea on exertion, two-pillow orthopnea, and peripheral 2+ pitting edema. These signs and symptoms became progressively worse.G.J. was admitted to the hospital with a diagnosis of acute heart failure (HF).Physical Examination• VS: Temp. 99 o F, BP 150/90, HR 96 and irregular, RR 24, SpO2 90%• Assessment: CV: 3rd heart sound, 2+ pitting edema bilaterally up to the knees, jugular venous distention, 1+ pedal pulses in bilateral LE; Resp: rales, wheezesbilaterally• Labs drawn in ER: Complete blood count; Complete metabolic panel; PT/INR; serum digoxin level; BNPo Results:? Digoxin level 0.12 ng/mL (therapeutic range, 0.5-2 ng/mL)? BNP 800 pg/ml (normal less than 100pg/ml)? PT 20 & INR 2.5 (norm PT 11-13.5- INR 0.8-1.1; therapeutic range of (INR 2-3)? Glucose 120HCP Orders for Treatment• Admit to Telemetry Unit• O2 at 2 L per nasal cannula• Daily weights• Furosemide 40 mg IVP STAT x 1• Digoxin 0.25 mg IVP STAT x 1• Serum digoxin and K level in 24 hours after above meds completed• Contact PCP with lab results• Furosemide 20 mg PO daily• Digoxin 0.25 mg PO daily• Warfarin 5 mg PO daily• Propranolol 10 mg PO daily s: 1. What is the mechanism of action of digoxin? How does this action help the patient with congestive heart failure (CHF)? 2. Does the timing of the digoxin administration have a causative effect on decreasing serum digoxin levels? 3. What factors may affect the absorption of digoxin? 4. What are the adverse effects with digoxin? 5. What are special considerations when administering digoxin? 6. What is the mechanism of action of furosemide? What is the indication for this client? 7. What adverse effects should the nurse be assessing for in a client on loop diuretics? 8. What is fluid rebound and how is this phenomenon prevented? 9. What are the special considerations when administering furosemide IV? 10. Why are daily weights essential for this client? What information should the nurse teach to the client to be sure the weight is accurate? 11. What does the nurse hope to assess when she evaluates the client for effectiveness of the IV digoxin and furosemide? 12. Why is this client on propranolol? 13. What are common adverse effects of propranolol the nurse should monitor for in this client? 14. What are the special considerations when administering propranolol? 15. Why is this client on warfarin? 16. What lab test provides information on the therapeutic blood level of warfarin? Health Science Science Nursing NURSING 128

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