CHF and spiriva

[Bonny619]

My patient tomorrow was diagnosed with CHF in the past year, I saw nothing in her chart about COPD. She is in the hospital due to aortic aneurysm, she developed acute renal failure but that has resolved, her BUN and Creatinine are within normal limits as is her output.

Question is why is she taking an inhaled bronchodilator?

[Daytonite, BSN, RN]

i can never express enough that we should never assume that a patient's hospital chart is a complete story as to what is going on. in addition, you should always assume that there is more to the story than just a medical diagnosis. symptoms. what are the patient's symptoms? when you develop a care plan for a patient you assess them for symptoms (defining characteristics). doctors do the same. sometimes symptoms are treated first to give the patient relief before a diagnosis is completely determined. coughing and wheezing, two common symptoms of congestive heart failure can bring on bronchospam, which is one of the indications for giving spiriva. assessment is an ongoing activity by all healthcare professionals. you also haven't had an opportunity to do a thorough assessment either. the chart is only containing information about her immediate admission, not her full history. tomorrow make sure you make a thorough perusal of the chart and nursing history. i would recommend that you take today to read up on congestive heart failure and anticholinergics (which is what spriva is). chf is a disease that has a large effect on the function of the lungs and it progresses in stages. without further information it is hard to know what stage of heart failure this patient is in.

• http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=6817 - national guideline clearinghouse guidelines on the diagnosis and treatment of acute heart failure. includes an extensive definition of the disease.
  
• http://www-isu.indstate.edu/mary/chfmeds.htm - a chart listing the medications used for chf. the drugs are arranged by drug categories. initial dose, target dose, recommended maximal dose and major adverse reactions are also listed for each drug.
  
• http://www.pharmacology2000.com/special_topics/chf/chf1.htm - congestive heart failure
  
• http://www.pharmacology2000.com/cardio/chf/chfobj1.htm - management of congestive heart failure
  http://www.pharmacology2000.com/autonomics/cholinergics/cholin1.htm - about cholinergics - sprivia is an anticholinergic specific to muscarinic receptors. you can read about muscarinic receptors at this web page. the heart contains these particular receptors.

[Bonny619]

Thank you very much.