Heart Failure Assignment ... help !!!

UM Review RN, ASN, RN · May 16, 2006

Hi Tommy,

We usually don't mind helping out with questions, but we're probably not going to do your assignment for you.

The way your post is phrased, it almost looks like you simply copied the assigned questions verbatim and are now sitting back in your chair at the computer, waiting for an answer.

Tell us how far you've gotten in answering this problem, please.

Home Health Columnist / Guide · May 16, 2006

your textbook should be able to answer most of these questions especially why a med is given iv over oral route.

google search " chf + nursing " will come up with great articles to supplement your text /assigned articles

http://www.google.com/search?hl=en&lr=&q=chf+%2b+nursing+&btng=search [/url]

chf is a malfunction of the contractile properties of the heart leading to lower than ... the goals of nursing management of congestive heart failure are ...

www.csufresno.edu/nursing/n140/studassign/chf.htm

heart failure disease management protocol

chf handbook: understanding your heart failure medicines

tommygangstarr · May 18, 2006

Thanks for the websites Karen! It helped me heaps. Angie, I should have posed the question appropriately. Just wanted some advice on where to find information on the internet to help with my assignment. Cheers.

Daytonite, BSN, RN · May 18, 2006

i've been searching for internet links for you for a day now and kept getting side tracked because i ran across some other great sites that i needed to bookmark for future use. sorry. i particularly wanted to get you information about why the lasix is being given iv and not orally. it really goes to a fundamental of medication administration, but i can't find it on the internet.

http://www.americanheart.org/presenter.jhtml?identifier=339 - signs and symptoms of heart failure - the reasoning for giving ace inhibitors is also talked about here

http://www.clevelandclinic.org/health/health-info/docs/1800/1831.asp?index=8124 - monitoring weight and fluid intake. a third action you as a nurse can take is to take daily measurements of the patients lower legs at their largest circumference to determine if edema is subsiding.

http://www.globalrph.com/ace.htm - here is some information on ace inhibitors and a listing of them

http://www.globalrph.com/diuretics.htm - here is some information on diuretics as well as an extensive list of them. 80mg of lasix iv is not unusual. i have seen larger iv doses ordered on admission. i'm having a hard time finding the rationale for you, but the reasoning is because the body utilizes more of the iv dose and in within a much more rapid period of onset than an oral dose. the stomach acids destroy a percentage of most oral medications so they are not as effective as the iv route. in your scenario you have a lady who is in distress with her breathing and needs relief quickly, so iv lasix is the better choice than giving it to her orally. you would then monitor her intake and output, get a baseline weight (before giving the lasix), and i would also take baseline measurements of her lower legs at their largest circumference. these three actions would be continued on a daily basis to help determine the effectiveness of the medical treatment.

http://www.chfpatients.com/ace.htm - ace inhibitors and congestive heart failure

http://www.aafp.org/afp/980415ap/cohn.html - see the section entitled "mechanism of ace inhibitor effect" on this article about chf. it suggests a second reason.

cardiacRN2006, ADN, RN · May 21, 2006

Hi guys, need some assistance in the questions below. Thanks!
Nikki, a "frequent flier," is admitted to the emergency department with a diagnosis of heart failure. She was discharged from the hospital 12 days ago and comes in today stating, "I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks."
After further questioning you learn she is not strictly following the fluid and salt restriction ordered during her last hospital admission. She reports she has been gaining up to1 kg every day since her discharge.
1. What error in teaching most likely occurred when Nikki was discharged 12 days ago?
You chart the medications Nikki brought with her: enalapril (Amprace) 5 mg bd, digoxin o.125mg qid, rosiglitazone (Avandia) 4 mg, frusemide (Lasix) 40mg qid, Potassium Chloride 20mEq qid. The admitting physician orders all the medications but changes.the frusemide 40mg to 40mg intravenous push qid and 80 mg intravenously now.
2. What is the rationale for changing the method of administering frusemide?
3. You administer 80 mg frusemide IVP. Identify three strategies you would use to monitor the effectiveness of this medication.
Most heart failure admissions are related to fluid volume overload. Patients who do not require intensive care monitoring can most often be treated initially with IV diuretics, oxygen, and angiotensin converting enzyme (ACE) inhibitors.
4. How do ACE inhibitors help in CHF?
5. Nikki's symptoms improve with intravenous (IV) diuretics. She is ordered back on oral frusemide once her weight loss is deemed adequate to achieve a euvolemic state. What will determine if the oral dose will be adequate to consider her for discharge?
6. Nikki is ready for discharge. What key management concepts should be taught to prevent relapse and another admission?

You should try to answer these questions yourself as this is the foundation of Heart failure. Why don't you answer them and then people can comment on why your answer ir right?

Every one of those questions should be found in your textboook, and an understanding of the pathophys of HF.