Case Study, Management of Patients With Complications From Heart Disease

Objective:

George Brown is 72 years of age and is a male patient who is admitted with the diagnosis
of acute pulmonary edema secondary to acute left ventricular heart failure. The patient
has a history of coronary artery disease that has been treated medically. The patient is
anxious, pale, cold, clammy, and dyspneic. The vital signs are: BP 88/50, P 110, R 32,
and T 97°F. There are bubbling crackles and wheezing throughout the lung fields and the
patient is raising frothy blood-tinged clear sputum. The patient’s admission weight is 100
kg.

What first actions should the nurse take and what are the rationales for these
actions?

Have HOB elevated to 30 degress or more and oxygenate patient.

The physician ordered furosemide (Lasix) 40 mg IVP STAT and nesiritide

(Natrecor) with an IV bolus of 2 mcg/kg over 60 seconds, followed with a continuous
infusion of 0.01 mcg/kg/minute. The nurse looks up information on nesiritide on the
Internet before administering the medication. Available at:
www.rxlist.com/natrecor-drug.htm
What are the actions of the ordered medications that will help the patient?

The patient is having Lasix ordered to take out the excess fluids in the patients body. This
will promote an adequate more stable perfusion.

How should the nurse administer the two medications? Explain the rate of pushing
the furosemide and what rate should the nurse administer the nesiritide.

The nurse will administer the Lasix IV push 10 mg per minute. And the nesiritide of 2 mg
followed by IV infusion of .01mg.