...The nurse implements care and teaching related to Larry’s prescriptions for captopril, carvedilol, nitroglycerin patch, and furosemide. Please discuss specific nursing considerations and patient teaching for each medication. (15 points) Captopril- Can cause a permanent nonproductive, dry cough. May have first dose hypotensive effect May cause angioedema, which can occur up to 1 year after taking drug. Carvedilol- Dizziness and fainting with increased activity Decrease in tolerance for exercise Teach patient to report weight gain >2lbs in 1 day or 5lbs in 1 week. SOB Edema of feet or ankles Increased fatigue or weakness Teach patient to not abruptly stop taking due to risk for angina, heart attacks, sudden death, or rebound hypertension. May have adverse effects such as bradycardia, heart failure, wheezing, bronchospasm, or impotence. Nitroglycerin- Teach to apply to skin, upper arms, and upper...
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...|Action |Starting Dose |Target dose |Indications, Contraindications, Averse Effects | | |ACE Inhibitors |Block RAAS system, decrease |Lisinopril: 2.5-5 mg qd |Lisinopril: 20-40 mg qd |Initiate at low doses | |Lisinopril |symptoms and mortality |Enalapril: 2.5-5 mg bid |Enalapril: 10-20 mg bid |May cause angioedema, hyperkalemia, increased creatinine, symptomatic | |Enalapril |Block conversion of Angiotensin I |Captopril: 6.25-12.5 mg tid |Captopril: 50 mg tid |hypotension, cough (tickle in throat) | |Captopril |to angiotensin II | | |Takes days, weeks to months to see improvement | | |Afterload reduction | | | | |Hydralazine |Pure vasodilator |10-25 mg q6-8 hrs |75 mg q6 hrs or 100 mg q8 hrs |May cause tachycardia | | |Afterload reduction | | |Used for intolerance of ACE inhibitors, for additional BP control, or | | ...
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...Case Study 1 Heart Failure M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 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 strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. 1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? If M.G. is currently following her fluid and salt restriction strictly but is still exhibiting the symptoms of fluid overload in heart failure, there was most likely an error in regards to medication teaching. She would have been prescribed a diuretic to eliminate the fluid that what giving her shortness of breath, edema and weight gain but if not taken correctly or at all this would explain why M.G. is still having these manifestations. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. ...
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...Case Study 1 Heart Failure M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 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 strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. 1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? The patient most likely failed to adequately apply the fluid and sodium restrction diet properly. Upon discharge teaching, she probably did not have an appropriate understanding of how much soidum to restrict in her diet, as well as what foods may be high in sodium. She also may not have an adequate understanding of what a "fluid" restriction diet entails. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. a. Pioglitazone: Side effects:Severe weight gain and water retention (edema) are...
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...of the drugs I was about to administer. Firstly, I checked patient ID band to make sure I had a right patient and then checked the correct dose, right time and route before administering the medication.I felt so nervous when my patient ask me to explain for him what is the name of the med why I gave him this medication . My patient had hypothyroidism and we should give this medication to the patient at least half an hour before breakfast because food can destroy most part of this med. I injected heparin for him and learn about this med used for patient in hospital to prevent DVT during hospitalization and also we never need to message or press the site of injection. heart problem so I learned about cardiac medication. I learned about Carvedilol and the important part is checking blood pressure and pulse before this med. The provider ordered road test for him before discharge him. So ,we did it and that was normal amount of oxygen. Educating the patient about ‘’RED FOLDER” was very interesting . The patient had pretty knowledge and answer all of the question that primary nurse asked...
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...the lung). Your Creatinine (lab test) was 1.6, troponin (lab test) was 0.104 and no potassium or magnesium (lab tests) levels were provided. Your B-type-natriuretic-peptide (lab test) was greater than 3000. Your examination revealed intermittently irregular heart rate. Your lungs exam was unremarkable. You were given Lasix (medicine) intravenous (through the vein) stat (immediately) then every 12 hours. You were given Potassium Chloride (medicine) intravenous (through the vein) stat (immediately), Magnesium Sulfate (medicine) intravenous (through the vein) stat (immediately) and restarted on home medications of aspirin , Sotalol, Lisinopril, Lasix, Digoxin, Atorvastatin and Coumadin (all medicines). You were to hold off on taking Carvedilol (medicine) in the hospital. Based on the Interqual guideline criteria (a decision based program to determine medical need) for heart failure, the clinical guidelines were not met because oxygen saturation (test) was not less than 91 percent (test result) or oxygen needed. There was no documented Hepatomegaly (liver enlargement), Jugular venous distention (vein in the neck sticking out) or weight gain greater than or equal to 3 pounds over last 2 days. There was no documented Sodium (salt) restriction or continuous cardiac (heart) monitoring. We have to deny the admission to the acute level of care as not medically necessary as there is no indication of a serious condition requiring acute inpatient level of care. With no planned inpatient...
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...Nurse Driven Education for A Patient Diagnosed With Chronic Systolic Heart Failure Refusing Diagnostic and Interventional Procedures Heather Horsley Wilkes University School of Nursing Abstract Heart failure (HF) is a chronic progressive disease, arising from structural or functional disorders of the heart, in which incidence increases with age. This review attempts to describe the types and causes of HF while focusing on variable aspects of patient education that have a positive effect on patient outcome and quality of life. Specifically, the potential benefits of this education for a 55 year old male patient diagnosed by transthoracic echocardiogram with chronic systolic heart failure, who has refused physician deemed necessary diagnostic testing and treatment. Keywords: heart failure, nurse driven education, heart failure, self-care Nurse Driven Education for Patient Diagnosed With Chronic Systolic Heart Failure Refusing Diagnostic and Interventional Procedures Heart failure (HF) is a major health care concern affecting over 5.7 million people in the United States. It is responsible for 1 in 9 deaths and costs the nation over 32 billion in health care expenses each year (Center for Disease Control, 2013). HF is the most common reason for hospitalization of people older than age 65 (Hinkle and Cheever, 2014). According to Hinkle and Cheever, HF is a “clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles...
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...Black, an accomplishment for which he was awarded the Nobel Prize in Medicine in 1988 (Stapleton, 1997). Sir Black took a different approach to the treatment of angina pectoris—instead of using drugs to increase the amount of oxygen delivered to the heart, Black sought to find a drug that could reduce the amount of oxygen required by the heart. The drugs in this classification are subdivided into two categories: non-selective and selective (cardioselective). Major drugs in the non-selective beta-blocker category include carteolol, nadolol, penbutolol, pindolol, propranolol, sotalol, and timolol. Major drugs in the cardioselective category include acebutolol, atenolol, betaxolol, esmolol, metroprolol, and nebivolol. Some others, including carvedilol and labetalol also have alpha-adrenergic blocking effects, but are outside the scope of this paper. (Vallerand, 2013; Turley, 2010) Beta-blockers are prescribed for the treatment of hypertension, angina pectoris, cardiac arrhythmias, hypertrophic subaortic stenosis, prevention of myocardial infarction, congestive heart failure, migraine headaches, and glaucoma. (Vallerand, 2013; Hodgson & Kizior, 2013) Beta-blockers work to compete with sympathetic neurotransmitters1 for beta1 and beta2 adrenergic receptor sites. Beta1 receptors are found in cardiac muscle, and beta2 receptors in vascular, bronchiolar, and uterine smooth muscle. Stimulation of beta1 receptors causes an increase in heart rate and contractility. Stimulation of beta2...
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...Nutrition Care Plan for DM Debra H. Carcell Professor D. Gardner Nutrition / NTR 2050 South University Online Patient Summary: Debra M. is a 54 year-old African American female with a diagnosis of congestive heart failure approximately 4 years ago. Debra is a retired direct care specialist who lives alone in her childhood home. Her height is 4’10 inches (148 cm) and her current weight is 191 lb. (86.864 kg). She has a weight loss of 18 lb. over the last three weeks due to difficulty in breathing. She is experiencing difficulty in consuming large meals. She does not shop or cook for herself because she tires easily due to her condition. Debra did a 24 hour food recall and upon reviewing this information it revealed that she uses many processed and frozen foods. Her estimated caloric intake is approximately 1400 to 1600 kilocalories a day. Debra does not exercise because it tires her out to fast. Nutrition Assessment: 1. Food and Nutrient Intake a) Food / Nutrition Related History i) Energy Intake - Total Energy Intake: 1400 – 1600 kcal/day 2. Food and Beverage Intake a) Food Intake i) Amount of food: unable to consume larger food portions at one time ii) Types of meals consumed: processed, prepackaged and frozen meals because they are convenient for her to use 3. Micronutrient Intake a) Mineral/ Element Intake Sodium intake: excessive i) Sodium intake: excessive intake 4. Behavior a) Social Network i.) Debra does...
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...Generic Name | Brand Name | alendronate tablet | Fosamax | acebutolol | Sectral | Acyclovir | Zovirax 200, 400 mg | acyclovir capsule | Zovirax | acyclovir tablet | Zovirax | afeditab CR tablet | Adalat cc | albuterol inhalation solution | Proventil/Ventolin | albuterol tablet | Proventil | albuterol tablet | Ventolin | albuterol/ipratropium inhalation solution | DuoNeb | alclometasone dipropionate cream | Aclovate | alendronate Na | Fosamax | alfuzosin hcl | Uroxatral | allopurinol | Zyloprim | allopurinol tablet | Zyloprim | alprazolam | Xanax | amiloride/HCTZ | Modurectic | aminophylline | Aminophylline | amiodarone | Cordaron | amiodarone tablet | Cordarone | amitriptyline | Elavil | amitriptyline tablet | Amitriptyline tablet | amlodipine besylate | Norvasc | anastrazole | Arimidex | antihypertensive combinations | Hyzaar | Anucort-Hc Supp | Anusol-HC (suppository) | atenolol | Tenormin | atenolol tablet | Tenormin | atenolol/chlorthalidone | Tenoretic | atenolol/chlorthalidone tablet | Tenoretic | augmented betamethasone dipropionate | Diprolene AF Cream | baclofen tablet | Lioresal | baclofen tabs | Lioresal | belladonna alkaloids/phenobarbital | Belladonna alkaloids/Phenobarbital | benazepril | Lotensin | benazepril HCTZ tablet | Lotensin HCT | benazepril tablet | Lotensin | benazepril/HCT | Lotensin-HCT | benztropine mesylate | Cogentin | benztropine tablet | Benztropine tablet | bicalutamide...
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...Medication Sheet Medication/Dose/RouteClassificationGeneric/Trade Name | Action | ContraindicationAdverse Effects | Nursing Considerations | Acetaminophen/500mg/ By MouthAntipyretic& Analgesic (nonopioid)Acetaminophen/TylenolCarvedilol/6.25mg/By MouthAlpha- and beta-adrenergic blocker & AntihypertensiveCarvedilol/CoregDocusate Sodium/100mg/By MouthLaxative stool softenersDocusate Sodium/ColaceFurosemide/40mg/By MouthLoop diureticsFurosemide/Lasix | Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat.Carvedilol causes vasodilation by blocking the activity of α-blockers, mainly at alpha-1 receptors. It exerts antihypertensive effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM.Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial...
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...This assignment will take the form of a case study on a current patient with heart failure being nursed in a community setting. Due to confidentiality and patient privacy, the patient discussed will be referred to as John¹. John is an 82 year old gentleman who lives alone in sheltered accommodation. John’s son and daughter live close and take it in turns to visit daily. John is an ex-smoker who gave up 20 years ago, has long standing hypertension and is overweight having a BMI of 30 kg/m. John was diagnosed with heart failure a year ago after being hospitalised three times in the space of four months. Stewart (2004) feels that a diagnoses of heart failure is problematic in older patients as their symptoms can often mimic other diseases. According to the National Institute for Clinical Excellence Guidelines (NICE) 2003, hospitalisation accounts² for 70% of the £716 million pounds spent on heart failure annually. In this assignment the physiology of the heart will be discussed and how heart failure affects its performance. John’s symptoms, medication and how his condition was diagnosed will be discussed³. John’s future care and how it will be managed along with who will be involved in his care4. NICE (2003) defines heart failure as a “complex syndrome” that results from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a “physiological circulation”. Tendera5 (2005) states that heart failure...
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...medications prescribed under this class of drug include captopril (Capoten); lisinopril (Prinivil, Zestril); enalapril (Vasotec); and quinapril (Accupril) (AHA, 2015). A class of medicines that has similar benefits to the ACE inhibitors is the Angiotensin II receptor blockers. This class can be used in place of ACE inhibitors for people who may not be able to tolerate the ACE inhibitors well. Routine medications in this class include losartan (Cozaar) and valsartan (Diovan). In addition, a beta-blocker will be ordered. This class will slow the heart rate and reduce blood pressure. These medicines may also reduce the risk of some irregular heart rhythms. Common examples include: bisoprolol (Zebeta); metoprolol succinate (Toprol XL); and carvedilol (Coreg). Digoxin, classified as a digitalis glycoside, may be ordered as well. This medication increases the strength of the heart’s contraction and slows the heartbeat. It is commonly used in the treatment of CHF patients and heart rhythm problems such as atrial fibrillation. Additional Therapies The treatment of congestive heart failure is not solely reliant on lifestyle choices and medications. Adjuvant therapies are included in the treatment plan to help improve patient outcomes and compliance. Whether in a hospital setting or not, a nutritionist or dietician can be of benefit to CHF patients. Diet remains an important factor in the management of the disease. A nutritionist can provide education to the client about the preferred diet...
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...All of the following medications are gluten free unless otherwise noted Generic drugs can be produced from many manufacturers and not all manufacturers use the same fillers or excipients. When there is a generic drug listed the manufacturer will be in the parenthesis. This does not imply that these are the only gluten free manufacturers but that these were the only ones checked. ANALGESICS/NONSTEROIDAL Acetaminophen w Codeine (Teva) Advil Aleve Alka Seltzer Gold Alka Seltzer Heartburn Relief Anaprox Anaprox DS Arthrotec Aspirin Enteric Coated 325mg (Leiner,code #44/227, Watson) Aspirin 81mg chewable (Watson) Avinza Baby aspirin (Walgreens, Perrigo) Bancaps HC Bufferin-all products EXCEPT Bufferin regular 325mg tablet which does contain some gluten Butazolidin Carisoprodol (Watson, West-Ward) Cataflam Celebrex Clinoril Cyclobenzaprine (Mylan, Schein, Watson) Daypro Demerol Durabac Ecotrin (all strengths) Endocet Endodan Esgic (all forms) Excedrin Extra Strength Excedrin Migraine Feldene-contains gluten Fioricet / with Codeine Fiorinal Fiorinal caps-generic (West-Ward) Fiorinal tabs-generic (West-Ward) Fiorinal with Codeine Flexeril Flubriprofen (Novapharm) Hydrocodone/APAP all strengths (Mallinckrodt, Watson) Ibuprofen (Amneal, Pharm. Formulations) Indocin Indomethacin (Novapharm) Ketoprofen XR (Andrx) Lodine (tabs/caps/XL) Lorcet 10/650 Lorcet Plus Lortab (all forms) Motrin Childrens DF Conc. Drops Mobic Morphine IR tabs (Roxane) Morphine Sulfate Ext Release Tab (Endo) Motrin...
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...United International University Department of Bachelor’s Business Administration (BBA) Course: Business Communication Section: G Report No: 03 Submitted to Course Instructor: Mrs. Rezwana Karim Senior Lecturer, School of Business United International University Submitted By: Name: Biplob Sarkar ID: 111092163 biplob_bsp@yahoo.com Date of Submission: 22th July 2010 Acknowledgement We are indebted to many people for providing us encouragement and support during our learning and working while making this project and we want to show our gratefulness to these people. We are very much grateful to Rezwana Karim, our respected course instructor of “Business Communication”, who assigned us this challenging project. She always guided us to take and overcome this challenge successfully. Without her help in every step it was quite impossible for us to finish this project properly in time. Thanks to the authority and the management of General Pharmaceuticals Ltd. for helping us in every possible way. Our cordial thanks to Mr. Monowarul Islam Bhuiyan, Deputy Manager of Sales Promotion at General Pharmaceuticals Ltd. in particular for his enormous help and assistance, for providing us the required information about their marketing and sales area and other facilities using his valuable time. At every moment we remember all of our friends and peers who encouraged and helped us a lot for long, in every stage of this project...
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