Protonix & CHF

[EmxoRenee]

Hello,

I am working on a case study for nursing school (I'm sure you all remember how much fun those case studies are!) and have run across a medication order that confuses me a bit.

In our case study, our patient has a diagnosis of Congestive Heart Failure (CHF) due to arteriosclerosis and hypertension. She has an order for Protonix 40 mg/100 ml D5W q d. I know that Protonix is a proton-pump inhibitor often used for patients with GERD. Our patient in this case study has no mention of any history of GERD.

I am wondering why a patient with no history of GERD would be ordered to take Protonix. I have tried looking in my med-surg textbook, and in powerpoint presentations we were given to look over for CHF, but can't seem to find an explanation. The only thing I can come up with is perhaps they have her on it prophylactically to prevent any kind of heartburn/upper GI pain that the patient could mistakenly report as chest pain? Do I seem to be on the right track with my thinking, or did I completely miss the mark? Anyone who works with CHF patients and has seen this before that has a good explanation for this type of order would be greatly appreciated!

Thank you!

[203bravo, MSN, APRN]

You are on the right track --- prophylaxis PPIs are given to patient's who at an increased risk of developing GI issues, especially stress ulcers. This includes patients who are long term bed bound and are on anticoagulants for prevention of DVTs. Patients who are on long term NSAID or steroid therapy, especially if given together. As well as those patients that have a known history GERD or PUD.

Look at any other medication orders and see if there is a reason for Protonix prophylaxis... Is there an order for Heparin or other anticoag? Daily steroid? NSAID? etc...

Think about the patient as a whole and not just the specific disease process..

Best of luck.

[EmxoRenee]

Thank so much for your response!

[LovingLife123]

What is your patient's level of activity? I'm guessing with CHF, and in the hospital, it's low. How are they eating? When a patient is in a bed for a long period of time, the hydrochloric acid in their stomach kind of sits. That acid damages the stomach allowing for ulcers and will back up the esophagus. All of our icu patients get PPIs preventively.