Carciac Glycosides
CRITICAL THINKING CASE STUDY 1
1. A patient is admitted to the hospital emergency room with shortness of breath, cold, clammy
skin, a heart rate of 100 beats/minute, and a cough producing pink, frothy sputum. A probable
diagnosis of heart failure and pulmonary edema has been established. What nursing procedures
might be taken immediately to make her more comfortable? What drugs are likely to be
needed?
You would give the patient nitroglycerin, oral diuretics, beta blockers, ace inhibitors, and
vasodilators.
In order to make her more comfortable, you would give her oxygen.
2 A patient comes into the emergency room in a state of extreme anxiety, expressing a fear that he
is dying. His pulse is thready, rapid, and irregular with a rate of 150 beats/minute. A probable diagnosis
of atrial fibrillation is established. What drugs are likely to be needed? What other techniques are known
to be useful in stopping an attack such as this?
You will need cardiac glycosides and calcium channel blocker. Some other techniques to use are
to limit salt intake to 2 g a day, avoid excessive alcohol, fluid intake restriction, smoking should
be avoided, mild exercise, saturated fat intake should be decreased, and obese patients should
modify unhealthy behaviors.
3 A patient appears chronically ill. He has recurrent chest pain and reports shortness of breath.
The probable diagnosis is angina. What drugs are likely to be useful in managing his condition?
Nitrates would help relieve the patients pain, and beta blockers and-calcium channel blockers
would be useful to manage his conditions.
4 After a heart attack, a patient was placed on warfarin (Coumadin), 10 mg per day. He has
returned to work and feels well. However, he is annoyed that he has to have periodic blood tests and
checkups. How can you help him understand the need for these tests?
Warfarin (coumadin) is a anticoagulant, which may cause bleeding on the inside of your body.
This can result in death. We need to draw blood so we make sure you aren’t bleeding internally
and make sure that the drug is in therapeutic range.
5 The patient comes to the office to have his rash checked. He fears he may be allergic to his
warfarin (Coumadin). You see that he has large, deep-red spots on his forearms, some measuring 10 cm
in diameter. What is the cause of the rash? What should be done?
The cause of the rash is due to bleeding somewhere deep in his arm. He should stop taking the
coumadin so he can prevent further damage.
CRITICAL THINKING CASE STUDY 2
, 1.A nurse administered 125 mg of digoxin instead of 0.125 mg of digoxin intravenously. The patient has
developed a severe heart block dysrhythmia, and the slow heart rate has not responded to
administration of atropine and other measures. What will the nurse expect to give next? How could this
situation have been prevented?
The nurse should give phenytoin and lidocaine next. This could have been prevented by double
checking the dosage of the medication and check for leading zeros if there wasn’t one.
2 The nurse is making morning medication rounds. One patient, a 78-year-old man, states that he
has been nauseous and without an appetite and has experienced some diarrhea. He has been taking
digoxin for the past few weeks for the treatment of recently diagnosed heart failure. What should the
nurse do next? Explain.
The nurse should get an order to check the patients serum digoxin levels and report these signs
and symptoms to a health care provider. Since this patient is older, he is more prone to digoxin
toxicity.
3 A patient is receiving an ACE inhibitor, a diuretic, and a beta-blocker as treatment for mild heart
failure. He has a history of hypothyroidism, which is controlled by thyroid replacement hormones, and
chronic bronchitis. He states that he stopped smoking a year ago after smoking two packs a day for 30
years. This morning he complains of a dry cough but says he does not feel short of breath, even when
getting up to go to the bathroom. He is unable to produce any sputum. When the nurse listens to his
lungs, his breath sounds are clear except for very few scattered rhonchi bilaterally. His weight is the same
as yesterday's weight, and his ankles show only trace edema (2 days ago he had 21 edema on the edema
scale). His temperature is 98.4° F (36.9° C), his pulse is 88 beats/min, and his blood pressure is 124/86.
He says to the nurse, “This cough is awful! Is my heart failure getting worse, or am I getting pneumonia?”
What is the nurse's best answer?
“You do not have any worsening symptoms of heart failure, and no current symptoms of
pneumonia are present either. The cough you are experiencing is most likely due to your chronic
bronchitis, and is getting worse due to the ace inhibitor.”
Antianginals
CRITICAL THINKING CASE STUDY 1
D.K., a 72-year-old man, had an MI 5 years ago. He has been having angina attacks at night and at rest
while watching television. He complains of stabbing pain in the chest that lasts 5 minutes. Pain does not
radiate to the arm. D.K. is prescribed propranolol (Inderal), 20 mg q.i.d. His vital signs are blood pressure
108/58; pulse 56 (at times irregular); and respirations 28. His clinical history indicates that he has mild
asthma.
1. What other clinical information is needed in regard to D.K.'s health problem and drug?
CRITICAL THINKING CASE STUDY 1
1. A patient is admitted to the hospital emergency room with shortness of breath, cold, clammy
skin, a heart rate of 100 beats/minute, and a cough producing pink, frothy sputum. A probable
diagnosis of heart failure and pulmonary edema has been established. What nursing procedures
might be taken immediately to make her more comfortable? What drugs are likely to be
needed?
You would give the patient nitroglycerin, oral diuretics, beta blockers, ace inhibitors, and
vasodilators.
In order to make her more comfortable, you would give her oxygen.
2 A patient comes into the emergency room in a state of extreme anxiety, expressing a fear that he
is dying. His pulse is thready, rapid, and irregular with a rate of 150 beats/minute. A probable diagnosis
of atrial fibrillation is established. What drugs are likely to be needed? What other techniques are known
to be useful in stopping an attack such as this?
You will need cardiac glycosides and calcium channel blocker. Some other techniques to use are
to limit salt intake to 2 g a day, avoid excessive alcohol, fluid intake restriction, smoking should
be avoided, mild exercise, saturated fat intake should be decreased, and obese patients should
modify unhealthy behaviors.
3 A patient appears chronically ill. He has recurrent chest pain and reports shortness of breath.
The probable diagnosis is angina. What drugs are likely to be useful in managing his condition?
Nitrates would help relieve the patients pain, and beta blockers and-calcium channel blockers
would be useful to manage his conditions.
4 After a heart attack, a patient was placed on warfarin (Coumadin), 10 mg per day. He has
returned to work and feels well. However, he is annoyed that he has to have periodic blood tests and
checkups. How can you help him understand the need for these tests?
Warfarin (coumadin) is a anticoagulant, which may cause bleeding on the inside of your body.
This can result in death. We need to draw blood so we make sure you aren’t bleeding internally
and make sure that the drug is in therapeutic range.
5 The patient comes to the office to have his rash checked. He fears he may be allergic to his
warfarin (Coumadin). You see that he has large, deep-red spots on his forearms, some measuring 10 cm
in diameter. What is the cause of the rash? What should be done?
The cause of the rash is due to bleeding somewhere deep in his arm. He should stop taking the
coumadin so he can prevent further damage.
CRITICAL THINKING CASE STUDY 2
, 1.A nurse administered 125 mg of digoxin instead of 0.125 mg of digoxin intravenously. The patient has
developed a severe heart block dysrhythmia, and the slow heart rate has not responded to
administration of atropine and other measures. What will the nurse expect to give next? How could this
situation have been prevented?
The nurse should give phenytoin and lidocaine next. This could have been prevented by double
checking the dosage of the medication and check for leading zeros if there wasn’t one.
2 The nurse is making morning medication rounds. One patient, a 78-year-old man, states that he
has been nauseous and without an appetite and has experienced some diarrhea. He has been taking
digoxin for the past few weeks for the treatment of recently diagnosed heart failure. What should the
nurse do next? Explain.
The nurse should get an order to check the patients serum digoxin levels and report these signs
and symptoms to a health care provider. Since this patient is older, he is more prone to digoxin
toxicity.
3 A patient is receiving an ACE inhibitor, a diuretic, and a beta-blocker as treatment for mild heart
failure. He has a history of hypothyroidism, which is controlled by thyroid replacement hormones, and
chronic bronchitis. He states that he stopped smoking a year ago after smoking two packs a day for 30
years. This morning he complains of a dry cough but says he does not feel short of breath, even when
getting up to go to the bathroom. He is unable to produce any sputum. When the nurse listens to his
lungs, his breath sounds are clear except for very few scattered rhonchi bilaterally. His weight is the same
as yesterday's weight, and his ankles show only trace edema (2 days ago he had 21 edema on the edema
scale). His temperature is 98.4° F (36.9° C), his pulse is 88 beats/min, and his blood pressure is 124/86.
He says to the nurse, “This cough is awful! Is my heart failure getting worse, or am I getting pneumonia?”
What is the nurse's best answer?
“You do not have any worsening symptoms of heart failure, and no current symptoms of
pneumonia are present either. The cough you are experiencing is most likely due to your chronic
bronchitis, and is getting worse due to the ace inhibitor.”
Antianginals
CRITICAL THINKING CASE STUDY 1
D.K., a 72-year-old man, had an MI 5 years ago. He has been having angina attacks at night and at rest
while watching television. He complains of stabbing pain in the chest that lasts 5 minutes. Pain does not
radiate to the arm. D.K. is prescribed propranolol (Inderal), 20 mg q.i.d. His vital signs are blood pressure
108/58; pulse 56 (at times irregular); and respirations 28. His clinical history indicates that he has mild
asthma.
1. What other clinical information is needed in regard to D.K.'s health problem and drug?
