Chapter 30: Heart Failure Flashcards
Digitalis (routes)
IM, parental and PO
Oral absorption is 50% to 80% complete
When digoxin is given by the IV route, the onset of action occurs within 5 to 30 minutes and reaches a peak effect in 1 to 5
hours; complete absorption of the drug occurs with IV administration
Digitalis (use)
management of mild to moderate heart failure in adults and children or control of the ventricular response rate in adults with chronic atrial fibrillation, used in children with heart failure to enhance contractility
Digoxin should not be used as first-line therapy for heart failure in adults greater than 65 years old, because of possible renal failure
Dosage must be reduced by approximately 50% with concurrent administration of amiodarone hydrochloride, quinidine, nifedipine, or verapamil
Digitalis (assessment)
assess the patient’s cardiac status, obtain an accurate body mass assessment, and assess the patient for renal impairment to ensure that an accurate dosage of medication is administered
Assess the apical pulse at the point of maximal impulse for one full minute, if HR is less than 60 beats/min in adults, 70
beats/min in older children, or 100 beats/min in younger children, the nurse does not give the drug and notify the health care provider
Digitalis (pt. teaching)
In heart failure, digoxin strengthens the heartbeat to relieve symptoms such as ankle swelling, shortness of breath, and fatigue
In atrial fibrillation, digoxin slows the heartbeat and decreases symptoms such as fatigue
Count your pulse for a full minute prior to taking your daily dose of digoxin. If your pulse rate is less than 60 beats/min, hold the dose of digoxin, and notify your health care provider
Take digoxin with food or after a meal. Dairy products will delay absorption
Limit sodium intake and get an adequate intake of potassium if you are also taking a loop diuretic
Digoxin toxicity
Digoxin (Lanoxin), derived from the foxglove plant of the genus Digitalis, is the prototype drug of this class
Patients with hypokalemia can develop digoxin toxicity even when the serum digoxin level is not considered to be elevated
Other adverse effects include dizziness, nausea, vomiting, loss of appetite, abdominal discomfort, vision changes (yellow–green halos and problems with color perception), blurred vision, and mental changes identified in medications administered to treat digoxin toxicity.
Digoxin is discontinued, not just reduced in dosage
Heart Failure s/s (left side)
decrease in cardiac output. Edema, pulmonary edema, pulmonary congestion, such as dyspnea, orthopnea, cyanosis, cough,
hemoptysis, crackles, anxiety, and restlessness, SOB, constant coughing, weight gain
Heart Failure s/s (right side)
chest discomfort, breathlessness, palpitations, and body swelling, Cool extremities, Diaphoresis, Dyspnea, Hypotension, Listlessness, Tachycardia, Fatigue, edema
Heart Failure (Assessment)
assess for left side chronotropic effects, hypertension, labs and special a high-sodium load, drug-to-drug interactions, sodium and water retention, edema, response to diuretics.
assesses the therapeutic effects of the medications.
Rales on lung auscultation indicative of pulmonary edema.
Decreased breath sounds on lung auscultation suggestive of pleural effusion.
S3 gallop on heart auscultation indicative of elevated left ventricular enddiastolic pressure. Assessed for edema, dyspnea, cough, SOB, chest pain, fatigue.
Review lab work and work closely with the medical team for a positive outcome should be on a cardiac monitor/telemetry always monitor
Heart Failure (Interventions)
lifestyle changes (quit smoking, low sodium diet),
cardiac catheterization, Echocardiogram, Coronary angiography, Myocardial biopsy, Pulmonary functions studies, Stress testing, Ventricular assist device (VAD)
surgery, Heart transplant surgery
Heart Failure (expected Outcomes)
Patient will perform activities within their limitations so as not to stress cardiac workload
The patient will exhibit optimal cardiac output, indicated by vital signs within acceptable ranges, absence/control of dysrhythmias, and absence of heart failure symptoms
