Sixty-three-year-old Jonathan Stevens visits the healthcare clinic complaining of increasing
fatigue and difficulty breathing. Physical assessment findings include a rapid, irregular heart rate
of 138 beats/min, BP of 140/86 mm Hg, and a respiratory rate of 28 breaths/min. His breath
sounds are clear with fine crackles in the bases bilaterally. He has positive jugular vein
distention (JDV) bilaterally and 1+ pitting edema of his ankles bilaterally. His initial medical
diagnosis is heart failure (HF). Jonathan is immediately admitted to the acute care facility for
further evaluation and treatment.
Risk factors
Heart failure occurs most commonly in clients over the age of 60 and occurs more commonly in
males than females.
Question 1: In addition to these two risk factors, what other risk factors will provide the nurse
with the best data for the heart?
Clinical Manifestations
Question 2: Name one assessment finding indicating that Jonathan is experiencing right-sided
heart failure.
Cardiac Dysrhythmias
Left-sided heart failure results in pulmonary fluid overload, and right-sided heart failure results in
peripheral fluid overload. Left-sided heart failure usually occurs first and can trigger right-sided
heart failure.
Upon admission to the Cardiac Nursing Unit, Jonathan’s dyspnea continues. He reports fatigue
but denies chest pain. The nurse places Jonathan on oxygen via a nasal cannula at 3L/min and
a cardiac telemetry monitor. The ECG recording shows no discernible P waves, and a rapid,
irregular ventricular response (QRS complexes). This corresponds with Jonathan’s pulse rate,
which is 136 and irregular.
Question 3: What cardiac dysrhythmia is Jonathan most likely experiencing?
Question 4: Based on Jonathan’s cardiac dysrhythmia, what would the nurse implement first?
Diagnostic Studies
Jonathan is scheduled for a chest-x-ray and 12 lead electrocardiograph (ECG). Additional
diagnostic studies that may be performed include echocardiography and pulmonary artery
catheterization.
Question 5: Name the diagnostic test used to measure the pressure within the right atrium?
Medication Administration
The HCP prescribes the following medications for Jonathan:
Digoxin (Lanoxin) 0. 125 mg IV every 6 hours x 4 doses, then 0.25 mg orally, daily
Furosemide (Lasix) 40 mg IV push, daily.
Captopril (Capoten) 12.5 mg orally, three times a day
Docusate sodium (Colace) 100 mg orally, twice a day.
Carvedilol (Coreg) 3.125 mg orally, twice a day.
Warfarin (Coumadin) 5 mg orally, daily.
Question 6: The nurse prepares a dose of digoxin )Lanoxin) 0.125 mg via IV push. The
medication is supplied as 0.25 mg in 2 mL. How many mL should the nurse prepare to give?
(Enter numeric value only. If rounding is necessary, round to the whole number).
Question 7: What assessment is the most important prior to the administration of captopril
(Capoten)?
Question 8: What is the expected outcome of digoxin (Lanoxin) therapy?
Nursing Diagnoses and Interventions
Question 9: List one priority nursing diagnosis to be included in the plan of care.
Question 10: List one intervention that should be implemented based on the diagnosis of activity
intolerance

1.Among the most prevalent underlying causes of heart failure are myocardial infarction, coronary artery disease, and ischemic heart disease. Myocardial infarction is, in fact, the most frequent cause of heart failure. Inquiring into Jonathan's hypertension is another important, underlying factor that can lead to heart failure.

2.Edema.

Peripheral congestion from right-sided heart failure comes from the right ventricle's inability to efficiently pump blood from the heart to the lungs. This leads in edema, JVD, an enlarged liver, abdominal ascites, and weight gain.

3.sinus tachycardia.

Heart rate of more than 100 beats per minute, steady rhythm, and P waves are characteristics of sinus tachycardia.

4.provide the digoxin stat dosage as directed (Lanoxin).

If a digoxin dose has already been prescribed, it should be taken before moving forward. Digoxin is an effective treatment for Jonathan's specific type of cardiac dysrhythmia since it reduces the heart rate and strengthens the heart's contractions.

5.Pulmonary artery catheterization.

In the context of critical care, pulmonary artery catheters are utilized to manage critically ill patients. Right atrial and pulmonary artery pressures can be measured using catheterization, which then informs treatment.

6.1D/H x V = X 0.125 mg divided by 0.25 mg times 2 mL = 1 mL

7.Blood pressure

Angiotensin converting enzyme (ACE) inhibitor capoten is used to treat hypertension. In patients with heart failure, ACE medications have been demonstrated to increase survival. It is possible to lessen the stress on the heart by lowering blood pressure (reduced afterload). Jonathan's blood pressure should be checked by the nurse to make sure the medication is working as intended and that hypotension does not develop.

8.1.0 ng/mL of serum digoxin.

Between 0.5 and 2.0 ng/mL is the digoxin therapeutic range. In order to reach a therapeutic level as soon as feasible, Jonathan was started on a loading dose of digoxin. Toxic concentrations are those above 2.4 ng/mL. Any patient receiving digitalis should be closely watched for digitalis toxicity signs.

9.Impaired gas exchange.

Less oxygen is available for exchange as the lungs' tissues fill up with fluid, which lowers the oxygenation of the tissues. Decreased cardiac output and activity intolerance are two more serious conditions.

10.Encourage frequent rest periods.

In order to encourage rest, the nurse should put into practice strategies including allowing for enough downtime and determining whether hypnotic medication is necessary before bed. The nurse should also take steps to help the client with transfers and ADLs in order to limit the amount of energy the client uses.

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