Cardio Cases
Case #1 – diltiazem, heparin, warfarin
A 45-year-old female presents to the emergency room with complaints of a “racing heart” and
palpitations. EKG reveals atrial fibrillation with heart rate 150-160 bpm. The patient weight is
160 pounds. The patient denies knowledge of previous Afib.
1. Is the patient at risk for thrombus formation that could lead to MI or CVA? Why?
2. The patient is complaining of dizziness and weakness. She appears pale and diaphoretic.
Why?
3. Imagine her blood pressure. What is it?
4. For each medication below, what is the intended effect?
diltiazem 0.25mg/kg IV over 5 minutes, followed
by 10 mg/hr continuous IV administration
initiate low dose heparin protocol
warfarin 5 mg PO daily
Case #2 – morphine, aspirin, nitroglycerin, clopidogrel
A 55-year-old male presents to the emergency room with complaints of chest pain that woke him
up from sleep. The patient appears diaphoretic and anxious. He describes the chest pain as
“crushing” and “heavy.”
waist circumference 42 inches, BMI 31.2
fasting blood glucose 110 mg/dL, LDL 155, HDL 36, Triglycerides 189
BP 145/76
Home medications: aspirin 81 mg PO daily, niacin 500 mg PO every night.
Cardio Cases
1. What is metabolic syndrome? Thoughts about his home medications?
2.
For each medication below, what is the intended effect?
Aspirin chewable 81 mg x 4 tablets, PO stat,
instruct patient to chew
Morphine 2-5 mg IV prn for chest pain
Nitroglycerin 0.5 mg SL prn, may repeat x 2, 5
minutes apart
3. The patient begins to complain of a headache and dizziness. Why? What actions
should the nurse perform?
4. The patient is transferred to the cardiac cath lab for diagnostic testing and treatment.
A 90% blockage of the right coronary artery (RCA) was diagnosed; treatment include
angioplasty and stent placement. An order was placed for clopidogrel 600 mg PO
stat, followed by 75 mg PO daily. What is the purpose of the medication order?
5. What patient teaching should be included for a patient discharged home on sublingual
nitroglycerin tablets?
Cardio Cases
Case #3 – digoxin, furosemide, ACE-inhibitors
A 74-year-old woman lives independently at home and manages the disease heart failure well.
While she struggles walking down her long, gravel driveway to the mailbox, she is able to care
for her home and cook simple meals in the kitchen. The home health nurse checks in with her
every other day to review her daily weight / BP / HR log and to draw any routine blood work.
During a medication a review, the nurse notes the patient is taking the following medications:
1. For each medication below, what is the intended effect and HOW will it achieve it?
furosemide 20 mg PO twice a day
lisinopril 5 mg PO twice a day
digoxin 250 mcg PO once a day
During a home healthcare visit, the nurse noticed the patient had been growing progressively
weaker; she was not able to walk short distances or cook her own meals. The nurse insisted she
seek immediate medical attention. The patient presents with ankle edema, dyspnea on exertion,
and orthopnea. On admission, she is severely dyspneic and can answer questions only with oneword phrases. She is diaphoretic, with a heart rate of 132 beats/min and blood pressure 98/70.
She is extremely anxious.
2. For each medication below, what is the intended effect and HOW will it achieve it?
furosemide 40 mg IV stat, repeat
every 12 hours
digoxin 0.5 mg IV stat, then 0.125
every 6 hours for 3 doses
morphine 2 mg IV stat, then 2 mg
IV PRN for dyspnea or chest pain
Cardio Cases
3. The physician also orders an EKG now, repeat prior to each digoxin dose / BMP once &
daily / BNP & serum digoxin level now. What is the significance with these orders?
EKG
BMP (basic metabolic panel)
BNP (brain natriuretic peptide)
serum digoxin level
4. Review the lab values provided. What do they indicate? What should the nurse do next?
digoxin 0.4 ng/mL
BNP 975 pg/mL (no need to
memorize normal)
K 3.2 mEq/L
Cr 1.1
BUN 24
Cardio Cases
5. You are assisting the patient complete her menu selection. What foods should the patient
include?
6. Consider the addition of spironolactone 12.5 mg PO twice a day – Why is spironolactone
often concurrently administered with furosemide?
7. Upon discharge, what patient teaching should the nurse provide regarding the
administration of digoxin? This should be a very long list.