1. Video Case Study: Heart Failure.
a. What is the pathophysiology of heart failure?
In heart failure, the heart does not pump effectively. This can occur for many reasons,
but the most common one is there has been damage to the heart tissue. The heart is
not able to pump enough fluid forward so fluid then backs up. This fluid backup
increases work on the heart as it tries to keep up but cannot. Early detection of
worsening HF may help prevent an acute episode requiring hospitalization.
b. Why did Mr. Stone develop heart failure?
Mr. Stone did not take his medications as directed, therefore he is currently not taking
any of his medications.His symptoms were increased fatigue, SOB, paroxysmal
nocturnal dyspnea and weight gain
c. What are the possible treatment plans for heart failure:
Possible treatment plans for HF are medication to treat the HF.Treatment plans focus
on the quality of life. The drugs that are administered to treat ADHF (including diuretics,
vasodilators, and ACE inhibitors) are often administered intravenously and can cause
serious side effects. The nurse must assess patients taking these medications to ensure
that they are being tolerated.
If the patient is able to lie flat, it indicates improved respiratory status and improvement
in ADHF symptoms. Normal renal labs and diuresis are indicators that drug treatments
are working
d. What nursing interventions/actions must nurses implement when taking
care of a patient with heart failure?
Some nursing interventions / actions nurses must implement when caring for a HF
patient include:
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Monitor intake & output & administer diuretics as MD orders. This is to manage
the excess fluid volume related to CHF.
Promote & assist the patient to do regular activities. This is to prevent activity
intolerance due to decreased cardiac output.
Encourage the patient to eat small, frequent meals that are low in sodium or a
low sodium diet. This is because sodium enhances water retention, so it worsens
the symptoms of CHF. Small frequent meals also help avoid fatigue associated
with CHF.
2. Video Case Study: Look-a-like/sound-a-like medications.
a. What error did the nurse discover in the scenario?
The Metronidazole was labeled as Fluconazole. Metronidazole is an antibiotic while
Fluconazole is for yeast infections.
b. What steps should a nurse take to minimize the risk of a medication error?
To ensure safe medication preparation and administration, it is best to perform the “7
rights of medication administration: right patient, right drug, right dose, right time, right
reason and right documentation.
c. What information does the Institute for Safe Medication Practices provide to
help nurses minimize risk of medication
errors? Give 3 examples.
Storing, stocking, and standardizing medications: Medication mistakes can be reduced
or eliminated by standardizing the time at which drugs are provided, the concentrations
of available pharmaceuticals, and the amount of drugs in patient care areas.
d. What steps should the nurse take if it is discovered that the pharmacy
provided the wrong medication or that the patient received the wrong
medication?
If the pharmacy provided the wrong medication, the nurse should notify the pharmacy
immediately of this error.
If the patient received the wrong medication, first you would want to assess the patient
VS, and also notify the patient and family at that point. Then notify the rest of the care
team, after you’ll document the error and report it to the hospital safety committee.
e. Develop a list of 5 to 10 look-a-like/sound-a-like medications.
Calciferol and Calcitriol
Ephedrine and Epinephrine
Diltiazem and Diazepam
Clonidine and Klonopin
Inderal and Indocid
Fluconazole and Metronidazole
Hydroxyzine and Hydralazine
Dopamine and Dobutamine
Fluoxetine and Duloxetine
Cosopt and Trusopt
3. Titrating Continuous IV medications
a. Why does an IV medication need to be titrated?
Clients in critical units may be unstable and require careful dosing and titration of
medication to promote recovery. When titrating a continuous IV medication, you adjust
the number of minor medication amounts, increasing or decreasing, maintaining
assessment findings within a prescribed range.
b. What is the role of the nurse in monitoring a patient when an IV medication
is being titrated?
Monitoring, and maintaining, vital signs frequently, cardiac output, sedation levels, and
documenting.
c. You are caring for a patient on continuous IV nitroglycerin. You are to start
the infusion at 5 mcg/min and increase the dose by 5 mcg every 5 minutes. You
have on hand nitroglycerin 25 mg in D5W 250 mL and must calculate how many
mL/hr to give. Calculate the answer and explain your work.
25 mg / 250 mL = X mg / 1mL
250X / 250 = 25 / 250
X=0.1
Desired = 5mcg (0.005mg) Have = 0.1mg/mL
0.005mg(60min) x 1mL / 0.1mg = 3 mL / hr
Ans: 3 mL/hr