Case Scenario:

Mr. H, an 82-year-old man who is widened and lives alone, arrives in the emergency room complaining he has had
difficulty breathing, especially at night, associated with nausea, for the past week. He states that he must sleep with
two pillows to breathe more easily at night and still does not get a good night’s rest. He also complains of a cough
that is worse at night and relieved by nothing. Mr. H has pneumonia.

Assessment of Mr. H reveals the following;

Vital signs

temperature, 98F

apical heart rate 86 beat s/min and irregular

respiratory rate, 36 breaths/min and labored

blood pressure, 170/96 mmHg

Skin – pale, cool, and diaphoresis

Inspiratory bibasilar crackles that do not clear with coughing

S3, heart sound on auscultation

Visible jugular vein distention

3+ bilateral pedal edema

A 12-lead ECG and a chest x-ray examination are ordered.

An intravenous line is started at a “keep vein oven” (KVO) rate.

Oxygen via mask

Admitted with a diagnosis of CHF.

1. What are the signs and symptoms of heart failure?

- Heart failure occurs when the heart muscle is unable to properly pump blood. Blood pools and fluid accumulates in
the lungs, resulting in shortness of breath. Coronary artery disease and hypertension weaken and stiffen the heart
over time, making it impossible to fill and pump blood properly. Heart failure can be long-term (chronic) or develop
quickly (acute).

sign and symptoms of heart failure:

 Heartbeats that are fast or irregular
 Concentration problems or a lack of alertness
 trouble breathing
 A dry, hacking cough
 A full (bloated) or hard stomach, loss of appetite or upset stomach

2. Give 7 lifestyle modifications to teach older adults with heart failure and discuss briefly.
 Salt control is crucial for heart failure patients for a variety of reasons. Hypertension is a key risk factor for
heart failure, and sodium can elevate blood pressure. Sodium can cause fluid retention and an increase in blood
volume, adding to the burden on an already fragile heart muscle.
 Maintain Blood Pressure Control Hypertension is a major cause of heart failure. The force exerted by blood
against the artery walls is referred to as blood pressure. When blood pressure rises to dangerously high levels,
the stress exerted on the artery walls can cause damage.
 Maintain a healthy body mass index (BMI). Maintaining a healthy weight necessitates a balance between
calories consumed and calories expended via physical activity. Portion management and physical activity are
two ways for keeping a healthy weight.
 Maintain a heart-healthy way of living. Choose foods that are low in trans and saturated fats, sugar, and salt.
Our bodies grow more sensitive to salt as we age, which can cause leg and foot swelling. Consume a wide
range of fruits, vegetables, and fiber-rich foods, such as whole grain products.
 When you smoke, you should quit since it is one of the healthiest things you can do for your heart. The arterial
walls that transport blood throughout the body are damaged by smoking. Furthermore, the chemicals included
in cigarettes and other tobacco products can harm the heart muscle directly, contributing to heart failure.
Nicotine is harmful in any form, including chewing tobacco and e-cigarettes, as is secondhand smoke
exposure.
 Limit Your Alcoholism Alcoholism is a major risk factor for heart failure. Alcohol is a cardiotoxin, which
means it may harm the heart muscle if consumed in large amounts. While some studies suggest that moderate
drinking may be beneficial to heart health, if you haven't already, don't start drinking alcohol. This includes the
risk of alcoholism as well as other health issues.
 Manage your worry. Learn how to handle stress, relax, and cope with problems to improve your physical and
mental health. Consider stress management strategies, meditation, physical activity, and talking to friends or
family about your problems.

3. Make a drug study on Digoxin including the nursing consideration.

Drug name:
Generic Name: digoxin
Brand Name: Digitek, Lanoxicaps, Lanoxin
Classification:  Cardiac glycoside, Cardiotonic

Dosage & Route

Patient response is quite variable. Evaluate patient carefully to determine the appropriate dose.

ADULTS
Loading dose, 0.75–1.25 mg PO or 0.125–0.25 mg IV. Maintenance dose, 0.125–0.25 mg/day PO.
Lanoxicaps capsules
Loading dose, 0.4–0.6 mg PO. Maintenance dose, 0.1 –0.3 mg/day PO.

Therapeutic actions
Digoxin is a cardiac glycoside that increases the power of myocardial contraction by acting as a positive inotropic
agent. It also reduces the conductivity of the atrioventricular (AV) node in the heart. Digoxin also affects vascular
smooth muscle directly as well as indirectly through the autonomic nervous system and an increase in vagal activity.

Indication
 CHF
 Atrial fibliration and atrial

Adverse effects 
Abnormal heartbeats, anorexia, nausea, and vomiting are among symptoms that might occur. Disorientation,
dizziness, sleepiness, restlessness, anxiety, agitation, and forgetfulness in the elderly, visual anomalies,
gynecomastia, local irritation (IM/SC injection), and fast IV delivery can all cause vasoconstriction and transient
hypertension.
Possibly Fatal: Arrhythmias of the heart in conjunction with heart block.
Contraindications
Toxicity to digitalis, ventricular tachycardia/fibrillation, and obstructive cardiomyopathy. Arrhythmias caused by the
existence of additional pathways 

Nursing consideration
Assessment
 Physical: Weight; orientation, affect, reflexes, vision; P, BP, baseline ECG, cardiac auscultation,
peripheral pulses, peripheral perfusion, edema; R, adventitious sounds; abdominal percussion,
bowel sounds, liver evaluation; urinary output; electrolyte levels, LFTs, renal function tests
 History: Allergy to digitalis preparations, ventricular tachycardia, ventricular fibrillation, heart
block, sick sinus syndrome, IHSS, acute MI, renal insufficiency, decreased K+, decreased Mg2+
increased Ca2+, pregnancy, lactation

Interventions

 WARNING: Monitor apical pulse for 1 minute before to administration; defer dosage if pulse is
less than 60 in an adult or 90 in a newborn; retake pulse in 1 hour. If the adult pulse remains 60 or
the infant pulse remains 90, discontinue use of the medication and notify the prescriber. Take note
of any deviations from the baseline rhythm or rate.
 Take care to distinguish Lanoxicaps from Lanoxin; their dosages are somewhat dissimilar.
 Take caution with dosage and preparation.
 Avoid intramuscular injections, which can be quite uncomfortable.
 Dilute the solution according to the manufacturer's directions and use the diluted solution
immediately.
 Avoid administering during meals; this will cause absorption to be delayed.

4. Give 6 objectives with interventions (for each objective) in the management of CHF.

1. Objective:
3+ bilateral pedal edema

Intervention:  
 Massage the regions that are reddened or blanched gently. Increases blood flow and reduces
tissue hypoxia. Note: Direct massaging of the inflamed region may result in tissue damage.
 Medications should not be given intramuscularly. Drug absorption is hampered by interstitial
edema and decreased circulation, which increases the risk of tissue breakdown and infection.

2. Objective:

temperature, 98F

apical heart rate 86 beat s/min and irregular

respiratory rate, 36 breaths/min and labored

blood pressure, 170/96 mmHg

Intervention

 Discard unneeded clothing and blankets. Reduces thermal radiation and increases evaporative cooling.
 Administered a tepid sponge bath. To increase the rate of heat escape by evaporation and conduction.
 Continue with bed rest. To minimize metabolic requirements and oxygen usage.
 Modify cooling measures in accordance with physical response. Shivering, which burns calories and speeds up
the metabolic rate in order to generate heat.
 Maintain a constant temperature in the surroundings. To avoid an increase in the patient's body temperature and
shivering.
 Specify the typical temperature and control. This is especially critical for people who have disorders that put
them at risk of hyperthermia.

3. Objective:
Handle normal levels of activity and activities, taking into mind any heart damage.

Intervention:
Motivate them to eat healthy, exercise regularly, and get enough sleep.

4. Objective:
Maintain a stable respiratory status within established parameters

Intervention:

Assess respiratory function: Listen to breath sounds Monitor O2 saturation

5. Objective:
The patient's heart condition will improve, with no signs of arrhythmias.

Intervention:
Auscultate apical pulses, heart rate and rhythm

6. Objective:
The patient's respiratory patterns will be effective without producing weariness.

Intervention:
Align the patient's body optimally in the semi-fowlers position for breathing