(SOLVED) Discuss each scheduled medication including rationale, mechanism of action, side effects and nursing implications.

Question

Case Study #4 Cardiac Compromise

As the on-coming nurse on a telemetry cardiovascular unit, you receive report about GC, who was admitted with a diagnosis of heart failure 48 hours ago. He is a 56 -year-old male who presented to his primary care provider with a 2-month history of worsening symptoms of dyspnea on exertion, a nonproductive cough, general fatigue, and decreased activity tolerance. Initially, the patient thought he had the flu; however, when the symptoms persisted, longer than expected, he sought medical attention. At the office, GC was found to have profound jugular venous distention, rhonchi in both lungs, and lower extremity swelling. After admission, he had an echocardiogram, and his serum BNP was found to be 1,560 pg/mL. Coronary angiography, which was performed to provide a definitive diagnosis, revealed no evidence of coronary artery disease. Echocardiogram reveals moderate concentric hypertrophy of the ventricles, moderate left ventricular dysfunction, ejection fraction $33\%$, and mild to moderate mitral regurgitation. Angiogram: normal coronary arteries, өjection fraction $33\%$, confirmed reduction in ventricular function with a ventriculogram. Past Medical History Hyperlipidemia diagnosed 3 years ago; hypertension diagnosed this past year. GC has had a history of obesity for over 20 years, and a history of hypothyroidism diagnosed 12 years ago. Physicardq Vital Signs: HR: 84 bpm; BP: 146/84 mm Hg; Temp: $36.8\mathrm{C}$; O2 sat: 94\% on $2\mathrm{L}$ NC; pt denies pain General appearance: Well-nourished male with appropriate affect and no apparent distress. Extremities: $2+$ pulses, skin warm, cap refill less than 3 seconds $3+$ pitting edema noted in lower ankles bilat extending to mid-calf. Pulmonary: Bibasilar crackles without wheezing or retractions; nonproductive cough. Cardiac: S1 and S2 present; S3 present at PMI. PMI displaced laterally into the anterior axillary line of his chest. Abd: Bowel sounds active $X4$ quads; liver span percusses at $7\mathrm{cm}$ right midclavicular line; abd nontender, soft, nondistended. ABC Hospital Inpatient Orders Laboratory Results

CASE STUDY:

1. Discuss each scheduled medication including rationale, mechanism of action, side effects and nursing implications. Include why each medication is given to this patient.

2. On Day 1 evening, the nurse notes a serum K of 3.5 mEq/L. Should the nurse call the physician?
Why or why not?

3. Describe the significance of GC's BNP results noted on the laboratory results table.

Expert Solution Preview

- Drugs used along with their rationale, mechanism of action, side effects and nursing implications: 

Side effects:............................