Case Study 1: Chapter 44: Agents for Treating Heart Failure
A student nurse is preparing drug cards for clinical. Their assigned patient has a
diagnosis of heart failure. The student nurse has to prepare a written teaching plan for a
patient who is receiving digoxin.
a. What is the pathophysiologic process of heart failure and the resultant clinical
signs? Would signs vary if the gender was male or female?
Heart failure occurs when the heart does not pump adequately, which causes a
fluid buildup in the heart and a congestion in the cardiovascular system.
The signs and symptoms vary depending on which side the failure is occurring
on.
Right sided heart failure: liver congestion, edema, jugular vein distension, and
nocturia.
Left sided heart failure: tachypnea, orthopnea, hemoptysis, dyspnea, anxiety,
and decreased oxygenation in the blood Gender differences in patients with heart failure
(Strömberg, 2003), where it states that women usually are diagnosed later in life than
men and also have more disfunction in their diastolic.
b. What are the therapeutic actions and indications for digoxin?
The indication of Digoxin is the treatment of atrial fibrillation and heart failure.
The therapeutic action of digoxin is to increase the force of contractions by
increasing the intracellular calcium. When the calcium is increased, it causes an
increase in urine output and a decrease in renin production, which results in a slower
heart rate and slowed AV conduction.
c. What important teaching points need to be included for a patient receiving
digoxin?
It is very important that a patient knows to take their heart rate before each
administration. It must be between 60 and 110. Anything out of that range, needs to be
brought to a doctors attention. Never skip doses, and if one is skipped, do not take
double doses. Always take on an empty stomach and without antiacids. Immediately
alert doctor for any signs of toxicity listed below.
d. What would be important to monitor for to alert for signs of Dig Toxicity?
Some signs of toxicity include blurry yellow green vision with halo of light,
arrhythmia, bradycardia, cholinergic, hyperkalemia, confusion.
Strömberg, A., & Mårtensson, J. (2003). Gender differences in patients with heart
failure. European journal of cardiovascular nursing : journal of the Working Group on
Cardiovascular Nursing of the European Society of Cardiology, 2(1), 7–18.
https://doi.org/10.1016/S1474-5151(03)00002-1