MORALES, JOHANA CLAIRE G.

BSN-NDA

CASE STUDY: PULMONARY EDEMA

Mr. Danilo is to be discharged from the hospital to home. He is 79 years old and lives
with his wife. He had just recovered from a mild pulmonary edema secondary to
congestive heart failure.

1. What would be the rationale for the nurse for advising Mr. Danilo to rest
frequently at home.?
 This is to reduce congestion in the lungs, the patient’s body should be
elevated. Relaxing and contracting leg muscles are important to
prevent clots. Continuous bed rest is a reasonable adjunct to diuretic
treatment in patients with CHF.
2. What position should the nurse inform the patient to sleep in when he goes home
and why?
 Proper positioning can help reduce venous return to the heart. The patient
is positioned upright, preferably with the legs dangling over the side of the
bed. This has the immediate effect of decreasing venous return,
decreasing right ventricular SV, and decreasing lung congestion.
3. Mr. Danilo will be discharged with a prescription of Digoxin 0.25 mg once daily.
What education should the nurse include regarding symptoms of toxicity?
 Maintain adequate hydration because toxicity is more likely when
dehydrated
 Symptoms of toxicity includes lethargy, confusion and gastrointestinal
symptoms like anorexia, nausea, vomiting, diarrhea, and abdominal pain.
4. Mr. Danilo also takes Lasix (40 mg) twice a day. What foods should the nurse
suggest that would supplement for potassium?
 Foods that supplement potassium includes dried fruits like raisins and
apricot, cooked spinach, beans, potatoes, banana, and avocado.

Briefly answer the following:

1. List the five categories of Cardiovascular Diseases:
 Arrhythmias
 Coronary artery disease
 Acute myocardial infarction
 Dilated myopathy
 Valvular disease
2. Describe Starling’s Law of the Heart.
 MORALES, JOHANA CLAIRE G.
BSN-NDA

 The Frank-Starling law of the heart (also known as Starling's law or the
Frank-Starling mechanism or Maestrini heart's law) states that the stroke
volume of the heart increases in response to an increase in the volume of
blood filling the heart (the end diastolic volume) when all other factors
remain constant. The increased volume of blood stretches the ventricular
wall, causing cardiac muscle to contract more forcefully (the so-called
Frank-Starling mechanisms). The stroke volume may also increase as a
result of greater contractility of the cardiac muscle during exercise,
independent of the end-diastolic volume. The Frank-Starling mechanism
appears to make its greatest contribution to increasing stroke volume at
lower work rates, and contractility has its greatest influence at higher work
rates. This allows the cardiac output to be synchronized with the venous
return, arterial blood supply and humoral length without depending upon
external regulation to make alterations.

3. List 3-5 purposes of cardiac catheterization:

 Widening a narrowed artery (angioplasty) with or without stent placement
 Closing holes in the heart and fixing other congenital defects
 Repairing or replacing heart valves
 Opening narrow heart valves
 Treating irregular heart rhythms with ablation
4. Discuss the implications of a low CVP reading:
 Low CVP reading may indicate hypovolemia. The consequences of
hypovolemia include reduction in circulating blood volume, lower venous
return and arterial hypotension. Myocardial failure may result from
increased myocardial oxygen demand in conjunction with reduced tissue
perfusion.
5. List 4 physiologic effects on the cardiovascular system that are associated with
the aging process:
 Decreased cardiac output
 Increased blood pressure
 Decreased compliance of the heart muscle
 Thickening of the heart valves

REFERENCES:
Medical-Surgical_Nursing_14th_ed._Brunner_&_Suddarth_2018[1]

https://pubmed.ncbi.nlm.nih.gov/12502909/
https://www.hsph.harvard.edu/nutritionsource/potassium/