CHF

Congestive
Heart Failure
Group 3 | NCMB 312 RLE
 TABLE OF CONTENTS

Importance of
Nursing
Diagnostic/
Care
Introduction Pathophysiology Laboratory Test Plan Drug Study

01 02 03 04 05
01 INTRODUCTION
 CONGESTIVE HEART FAILURE
Sometimes referred to as heart failure,
is the inability of the heart to pump
sufficient blood to meet the needs of the
tissues for oxygen and nutrients. Heart
failure is a clinical syndrome characterized
by signs and symptoms of fluid overload or
inadequate tissue perfusion.

The underlying mechanism of HF

involves impaired contractile properties of
the heart (systolic dysfunction) or filling
of the heart (diastolic) that leads to a lower
than normal cardiac output. The low
cardiac output can lead to
compensatory mechanisms that cause
increased workload on the heart and
eventual resistance to filling of the
heart.
Right-sided Heart Failure Left-sided Heart Failure

Weight gain Pulmonary congestion

Hepatomegaly Dyspnea
Edema Cough
Ascites Pink frothy sputum
Distended neck veins Pulmonary crackles
Oliguria and nocturia.
Orthopnea

The signs and symptoms of heart failure can be related to which

ventricle is affected. Left sided heart failure causes different manifestations
than right sided heart failure. In chronic heart failure, patients may have signs
and symptoms of both left and right ventricular failure.
CASE SCENARIO:
Dina, 65 year old female who had sustained previous inferior
and anterior myocardial infarctions is admitted to FUMC hospital
with complaints of progressive increase in breathlessness and
edema on lower extremities and fatigue over the
previous three weeks.

She reported history of chest pain and nocturnal dyspnea. Her

serum electrolytes were critically deranged; Potassium (K+) 1.31 mmol/L, and
Calcium (Ca++) level was 5.3 mmol/L cholesterol LDL 159 mg/dl, HDL 123 mg/dl,
Ejection Fraction and CK-MB creatine kinase MB were 35% and 27.36 U/L respectively.

Provisional diagnosis of congestive heart failure was made, and patient was treated
captopril 50 mg three times daily, furosemide 80 mg three times daily, isosorbide
mononitrate SR 60 mg once daily,aspirin 150 mg once daily and Digoxin, 25 mg PO OD
02 PATHOPHYSIOLOGY
 Non-modifiable Factor:
● More than 65 years old
● Female
INJURY TO MYOCARDIUM (HEART MUSCLE)
35% Ejection Fraction

↓ STROKE VOLUME CKMB creatine kinase

MB - 27.36 U/L

↓ CARDIAC OUTPUT
LDL - 159 mg/dl
HDL - 123 mg/dl
UNLOADING OF HIGH PRESSURE BARORECEPTORS IN CAROTID SINUS

LEGEND
↓ RENAL PERFUSION
DISEASE PROCESS

LAB RESULTS
RELEASE OF RENIN
SIGNS AND SYMPTOMS

DIAGNOSIS
CONVERTS ANGIOTENSINOGEN TO ANGIOTENSIN I
PREDISPOSING FACTOR

INFERIOR AND ANTERIOR MI

 ACE CONVERTS ANGIOTENSIN 1 TO
ANGIOTENSIN II

ALDOSTERONE
edema on lower extremities

SALT AND WATER RETENTION

(K+) 1.31 mmol/L

↑ HEART WORKLOAD (Ca++) 5.3 mmol/ L

chest pain FURTHER STRESS ON MYOCARDIUM

(Negative Remodelling and worsen LV
function)
nocturnal dyspnea

fatigue over the previous three weeks

CONGESTIVE HEART FAILURE
progressive increase
in breathlessness
 IMPORTANCE OF
DIAGNOSTIC AND

03 LABORATORY TEST
IN THE GIVEN
SCENARIO
Echocardiogram
During an echocardiogram, sound waves are used
to produce images of the heart and the blood
pumping through the heart. Electrocardiogram
can measure the ejection fraction. Ejection fraction
is a measurement, expressed as a percentage of
how much blood the left ventricle pumps out with
each contraction. This is to determine how well the
heart is pumping blood and to help diagnose heart
failure.

Normal:

50% to 75% according to the American Heart

Association.

Result: 35%- Decreased ejection fraction . The

amount of blood being pumped out of the
heart is less than the body needs.
Lipid Profile: Cholesterol
The lipid profile helps evaluate
cardiovascular health by analyzing cholesterol
in the blood. Too much cholesterol can build
up in the blood vessels and arteries,
damaging them and heightening the risk of
problems like heart disease, stroke, and heart
attack.
Low-density lipoprotein (LDL) cholesterol.

This is called the "bad" cholesterol. Too much

LDL cholesterol in the blood causes plaque to
build-up in the arteries, which reduces blood
flow.

High-density lipoprotein (HDL) cholesterol.

This is called the "good" cholesterol because it
helps carry away LDL ("bad") cholesterol,
keeping arteries open and your blood flowing
more freely.
Result:

LDL 159 mg/dl- Elevated LDL.

Therefore, the body has too much LDL

cholesterol, the LDL cholesterol can build up
on the walls of the blood vessels. This buildup
is called “plaque.” As your blood vessels build
up plaque over time, the insides of the vessels
narrow.

HDL 123 mg/dl- Elevated HDL.

Normal:

Low-density lipoprotein (LDL): 85-125 mg/dL

High-density lipoprotein (HDL): 40-80 mg/dL
CK MB- Creatine Kinase MB
The test is done with a blood sample. A needle is used to
draw blood from a vein in your arm or hand.

Measuring CK-MB is a common tool for diagnosing acute

myocardial infarction or heart attack. Creatine kinase (CK)
is an enzyme found in the muscles. Enzymes are proteins
that help the body's cells do their jobs. The level of the CK
enzymes rises when you have damage to muscle cells in
your body. CK-MB- Enzymes are found in the heart if it is
damaged.

Result: 27.36 U/L- Elevated CK-MB. Means that the heart

muscles are damaged. Elevated creatine kinase can signal
a heart attack or other serious condition.

Normal: Creatine kinase (CK)

Male: 38 – 174 U/L Female: 26 – 140 U/L

Basic Metabolic Panel
The basic metabolic panel typically involves eight
separate measurements and can provide relevant
information in many situations. Depending on the
context, the BMP can be used for medical
screening, diagnosis, or monitoring treatment. In
this case, BMP is used to measure the potassium
and calcium level of the patient which is essential
for the proper functioning of the cardiac muscle.

Eight distinct measurements are included in the

basic metabolic panel:

Glucose, Calcium, Sodium, Potassium,

Bicarbonate, Chloride, Blood Urea Nitrogen
(BUN), Creatinine
Basic Metabolic Panel
● Screening is a method of trying to find health problems
before they have caused symptoms to occur. A doctor may
prescribe the BMP as a screening test during regular
check-ups to try to detect possible underlying health
concerns.

● Diagnosis is the process of finding the cause after signs or

symptoms of a health problem have become apparent. The
BMP offers details about various aspects of how well the
body is functioning, which makes it useful in the diagnostic
process for a wide range of symptoms and medical
conditions.

● Monitoring involves follow-up testing that checks to see

how your condition changes over time or in response to
treatment.
Basic Metabolic Panel
Results:
Potassium (K+) 1.31 mmol/L - Decreased Potassium

Calcium (Ca++) level 5.3 mmol/L - Increased Calcium

The two most important electrolytes are potassium and

calcium. They are both vitally concerned with proper function
of the cardiac muscle. Both electrolytes are needed in the
proper amounts for contraction of the muscle and for the
proper conduction of the impulses through the special
conduction pathway in the heart. Hypokalemia and
Hypercalcemia affect the electrical impulses that regulate the
heartbeat, causing the heart to beat irregularly.

Normal Range:

Potassium: 3.5 mmol/L - 5.5 mmol/L

Calcium (serum): 8.6-10.mg/dL = 2.2-2.6 mmol/L

04 NURSING CARE PLAN
ACTUAL NCP
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Ineffective Short-term: Independent: Short-term:

-complaints of breathing pattern After 30 minutes of -Monitor vital signs -To provide After 30 minutes of
progressive increase related to nursing intervention baseline data. nursing intervention
in breathlessness immobility the patient will the patient was able
and fatigue. secondary to express relief or -Assess and record -The average rate to express relief or
fatigue as improvement in respiratory rate and of respiratory for improvement in
Objective: evidence by chest feelings of shortness depth at least every 4 adults is 12 to 20 feelings of shortness
-She reported pain and of breath hours. breaths per of breath
history of chest pain nocturnal dyspnea minutes. It is
and nocturnal Long-term: important to take Long-term:
dyspnea. After 1 hour of nursing action when After 1 hour of
intervention the when there is an nursing
-electrolytes were patient will maintain alteration in the intervention the
critically drange. an effective breathing pattern of patient maintains
pattern, as evidenced breathing to
an effective
-edema on lower by relaxed breathing detect early signs
extremities. as normal rate and of respiratory
breathing pattern,
depth and absence of compromises. as evidenced by
dyspnea relaxed breathing
-Monitor Arterial -To monitor as normal rate and
Blood Gas. oxygenation and depth and
ventilation status. absence of
dyspnea.

GOAL MET
ACTUAL NCP
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

-Evaluate nutritional status -Malnutrition may result in

(e.g. weight, albumin level, premature development of
electrolyte level) respiratory failure because it
reduces respiratory mass and
strength.

-Utilize pulse oximetry to -Pulse oximetry is a helpful tool to

check oxygen saturation detect alterations in oxygenation
and pulse rate initially

-Observe for flaring of -These signs imply an increased

nostrils. breathing effort.

-Most people panic when they

-Observe for perception of cannot breathe or have difficulty
respiratory distress and breathing. This anxious state may
anxiety. worsen the ability of breathing.

-Emotions and feelings, such as fear

-Assess the patient’s of a procedure or new diagnosis,
emotional state. can cause severe anxiety, leading to
hyperventilation episodes.

-Pain can hinder the patient from

-Assess for pain. taking in deep breaths. This shallow
breathing pattern can lead to
decreased oxygen intake and
accumulation of carbon dioxide.
ACTUAL NCP
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

-Educate patient of proper -These allow sufficient

breathing, coughing and mobilization of secretions.
splinting methods.

-Place patient with proper body -A sitting position permits

alignment: semi-fowler’s or maximum lung excursion and
high-fowler’s position for chest expansion.
maximum breathing pattern.

-Provide emotional support -A supportive environment can

during dyspneic episodes. reduce anxiety and oxygen
demand. It reduces respiration
and therefore slows fatiguing.

-Provide rest periods before -Scheduled rest periods allow the

and after activities. patient to conserve energy,
decreasing episodes of
respiratory distress.

-Provide bedside commode. -To reduce energy require in

going to the bathroom and
reduce heart workload.
ACTUAL NCP

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

-Provide small, frequent meals. -Smaller meals are more

comfortable to eat and
require less effort. By
consuming small
portions, the patient has a
chance to rest and regain
energy for the next meal
or activity.

-Encourage active ROM exercises, -Maintains muscle

deep breathing exercises, sitting up in strength, joint ROM, and
the bed/chair, hanging the legs over improve activity tolerance.
the bedside, standing, and walking Gradual progression of
for a few minutes. the activity prevents
overexertion and help
identify tolerated
activities.

Dependent: Dependent:
-Prove supplemental oxygen, as -To support breathing
ordered.

-To treat the cause of

-Administer ineffective breathing
medications (Furosemide, Isosorbide pattern.
Mononitrate, Aspirin, and Digoxin), as
ordered.
POTENTIAL NCP

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Objective: Risk for impaired Short term: Independent: Short term:

skin integrity ● Assess the overall -Skin is at risk because of
related to presence condition of the skin, edema on the lower
-Presence of edema After 1 hour of extremities of the After 1 hour of Nursing
of fluid retention note skeletal
on lower extremities. Nursing intervention patient intervention the patient
on lower prominence,
extremities the patient will: presence of edema, was able to
and areas of altered demonstrate behaviors
- Demonstrate circulation and or techniques to prevent
pigmentation. skin breakdown.
behaviors or
techniques to -Skin stretched over
● Assess for edema. edematous tissue is at
prevent skin Long Term:
risk for impairment.
breakdown
● Assess the surface -Patients who spend the After 8 hours of Nursing
that the patient majority of time on one
Long Term: intervention the patient
consumes most of his surface require a
or her time on (e.g., pressure reduction or was able to maintain
After 8 hours of mattress for pressure relief device to skin integrity
Nursing intervention bedridden patient, distribute pressure more
cushion for people in evenly and reduce the
the patient will: GOAL MET
wheelchairs). risk for breakdown.

-Maintain skin ● Monitor the patient -Medications in treating

integrity response to the underlying cause
and the edema of the
medication.
patient may lead to
another problem if not
monitored properly.
POTENTIAL NCP
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION
● Monitor input and output.
● Monitor serum
electrolytes.
● Encourage and instruct in
frequent position changes
(elevating legs above the
heart) in bed and chair.
● Provide and instruct in
good skin care (shower
instead of bath, washing
areas thoroughly using
mild soap, drying gently
and lubricating with lotion
or emollient)
● Check fit of shoes or
slippers and change as
needed.
● Encourage to wear clothes
that not tight.
RATIONALE EVALUATION
-Response to diuretics may lead to
fluid deficit.
-To prevent electrolytes depletion
caused by diuretics.
- Changing position off pressure
areas every few minutes in bed or
chair Reduces pressure on tissues,
improving circulation and reducing
time in any one area is deprived of
full blood flow.
-Excessive dryness or moisture
damages skin and hastens
breakdown.
-Edema may cause shoes to fit
poorly, thereby increasing risk of
pressure and skin breakdown on
feet
-To avoid irritation of the skin and
compromise circulation.
POTENTIAL NCP

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

● Encourage diet that are low in -Too much salt will result in fluid
sodium/salt. retention in the body.

Dependent:
-Administer medication (digoxin) -Treating the underlying cause
that will manage/treat the will decrease the risk of
underlying cause of edema in the developing an impaired skin
lower extremities of the patient integrity in relation to edema in
the lower extremities.
-Administer Diuretics (furosemide)
-To reduce or remove the
accumulated fluids in the lower
Collaborative: extremities of the patient.

-Consult with nutritionist if -The patient is an elderly.

indicated regarding nutrients that
aids in tissue repair, helps in
reducing accumulated fluid
Supplements may be needed to
promote general well-being and
healthy skin tissue. There are
foods that needs to avoid and
needed to take to help in treating
the edema of the patient.
05 DRUG STUDY
 GENERIC NAME: Captopril
BRAND NAME: N/A
CLASSIFICATION: Ace Inhibitor
DOSAGE AND FREQUENCY: 50 mg, TID

ROUTE: PO

Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of

MECHANISM OF ACTION: angiotensin I to angiotensin II, a potent vasoconstrictor.

Indicated in the treatment of congestive heart failure usually in

combination with diuretics and digitalis.
INDICATION
Captopril works by opening the blood vessels. This allows blood to flow
DRUG RATIONALE more easily and decreases how hard the heart has to pump. These
effects lower the blood pressure levels and improve the heart's ability to
pump blood.
 CONTRAINDICATIONS: Hypersensitivity to drug and other ACE inhibitors

There are no side effects that are given in the case scenario. But the possible side
effects are:
COMMON SIDE EFFECTS:
Cough, Angioedema, Hyperkalemia, Taste alteration, Orthostatic hypotension, Renal
failure, Leucopenia

● Give captopril an hour before meals as food decreases absorption

● Monitor blood pressure, WBC and serum electrolytes. Elderly patient may be more sensitive
to drug’s hypotensive effects.
● Inform patient that the drug can cause lightheadedness and cough.
● Instruct the patient to rest after taking the medicine.
● Raise side rails after taking the medicine for patient safety.
NURSING CONSIDERATIONS: ● Monitor input and output. Decrease output may indicate renal failure.
● Instruct the patient to increase oral fluid intake to facilitate renal function.
● Give the patient foods that she enjoys and can boost the immune system.
● Advice to keep a distance to people with viral infectious diseases.
● Advice patient to report signs and symptoms of infection such as fever and sore throat.
● Advice the patient to report signs and symptoms of angioedema such as swelling of the
face, lips, or mouth.
 GENERIC NAME: Furosemide
BRAND NAME: N/A
CLASSIFICATION: Diuretics
DOSAGE AND FREQUENCY: 80 mg, TID
ROUTE: PO

Furosemide inhibits tubular reabsorption of sodium and chloride in the proximal and
distal tubules and the thick ascending loop of Henle by inhibiting the
MECHANISM OF ACTION: sodium-chloride cotransport system resulting in excessive excretion of water along
with sodium, chloride, magnesium, and calcium.

Furosemide is indicated for the treatment of edema associated with congestive heart
INDICATION
failure.

Furosemide works by helping the body get rid of excess salt and water. It does this by
increasing the amount of urine the body makes thus the diuresis which decreases
DRUG RATIONALE
the pressure caused by excess fluid on lower extremities.
 Hypersensitivity to the drug
CONTRAINDICATIONS: Hypokalemia/Electrolyte depletion
Low blood pressure

There are no side effects that are given in the case scenario. But the possible side effects are:
COMMON SIDE EFFECTS: Peeing more than normal, feeling thirsty with a dry mouth, headaches, Dizziness, Muscle cramps, or weak
muscles

● Closely monitor vital signs especially BP.

● Monitor BP during periods of diuresis and through period of dosage adjustment.
● Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and
electrolyte balance may precipitate significant adverse reactions.
● Monitor serum potassium level
● Monitor I&O ratio and pattern.
NURSING ● Monitor for weight changes.
CONSIDERATIONS: ● Advise the patient to take it in the morning
● Advise the patient to avoid food high in sodium
● Assess hydration status. Assess skin turgor, mucous membranes, severe thirst, weak pulse, slow
capillary filling, decreased urine output, and hypotension.
● Eat foods high in potassium such as whole grains, meat, bananas, etc.
● Raise bed side rails for patient safety.
● If there is activity intolerance, provide a bedside commode.
 GENERIC NAME: Isosorbide Mononitrate
BRAND NAME: N/A
CLASSIFICATION: Nitrates
DOSAGE AND FREQUENCY: 60 mg, once

ROUTE: PO

Isosorbide mononitrate acts as a donor of nitric oxide (NO). NO causes a relaxation of

MECHANISM OF ACTION: vascular smooth muscle via the stimulation of guanylyl cyclase and the subsequent
increase of intracellular cyclic guanosine monophosphate (cGMP) concentration.

It is used to treat congestive heart failure and prevent chest pain/angina. Angina usually feels
INDICATION like a tight pain in the chest, neck or arm area. The pain comes from the heart muscle and is a
sign that part of it is not getting enough oxygen for the amount of work it is doing.

DRUG RATIONALE Given to the patient to relax the blood vessels and increase the supply of blood and oxygen to
the heart while reducing its workload where blood flows to areas which need it.
 -Hypersensitivity to nitrates
-Severe low blood pressure
CONTRAINDICATIONS:
-Hypovolemia/Low blood volume

There are no side effects that are given in the case scenario. But the possible side
effects are:
COMMON SIDE EFFECTS: Dizziness, Postural hypotension, Headache, Lightheadedness,Tachycardia, Flushing
(warmth, redness, or tingly feeling)

● Monitor vital signs and serum electrolytes.

● Notify physician if there are any rhythm disturbance ( e.g tachycardia and bradycardia),
symptoms of increased arrhythmias, palpitations, chest discomfort, shortness of breath,
fainting, and fatigue/weakness
● Advise the patient to take on empty stomach, 30 mins before meals or 1 hour after meal.
NURSING
● Swallow the extended-release tablet whole with a half glass of water. Do not split, crush, or
CONSIDERATIONS: chew it.
● Inform the patient that headache, dizziness, lightheadedness, or faintness may occur,
especially when you get up quickly from a lying or sitting position.
● Instruct the patient to rest after taking the medicine and get up slowly.
● Raise bedside rails for patient safety.
GENERIC NAME: Aspirin
BRAND NAME: N/A
CLASSIFICATION: Anti-platelet, Non-steroidal anti-inflammatory, Non-narcotic analgesic, Antipyretic,
DOSAGE AND 150 mg
once daily
FREQUENCY:

ROUTE: P. O

Blocks pain impulses in CNS, inhibition of prostaglandin synthesis; results from

MECHANISM vasodilation of peripheral vessels; decreases platelet aggregation by blocking
OF thromboxane A2
ACTION:

● There is no clear consensus on the use of aspirin in patients with congestive heart
failure (CHF). ASA use is beneficial and is recommended in many conditions that
INDICATION
frequently coexist with CHF, such as ischemic heart disease, and atrial fibrillation.

● A blood clot can quickly form and block the artery. This prevents blood flow to the
heart and causes a heart attack. Aspirin therapy reduces the clumping action of
DRUG RATIONALE
platelets — as it thins the blood, which helps prevent blood clots from forming
possibly preventing a heart attack.
 There are no known contraindication in the given case scenario But the possible contraindications:
● Known allergy with NSAIDs.
● Who have asthma.
CONTRAINDICATIONS: ● Who have peptic ulcer or poor kidney function.
● Who have bleeding disorders such as hemophilia.

There are no side effects that are given in the case scenario. But the possible effects are:
GI upset
COMMON SIDE EFFECTS: Drowsiness
Nausea and Vomiting
Changes in your vision

1. Monitor for signs and symptoms of drug allergy such as difficulty of breathing,or itchy skin, and rashes.
2. Instruct patient to take aspirin with food or after meal because it may cause GI upset if taken on an empty
stomach.
3. Instruct the patient not to chew or crush the tablet.
4. Advise patient to avoid alcohol when prescribed aspirin.
5. Instruct the patient to increase oral fluid intake to facilitate renal function.
NURSING
6. Instruct patient to report bloody stools, rapid or difficulty breathing, and confusion
CONSIDERATIONS: 7. Since aspirin may increase risk of bleeding. Instruct patient to use soft or electric toothbrush and other measure to
prevent bleeding
8. Monitor input and output. Decrease in output may indicate renal failure. Dark-colored urine that may indicate
hepatotoxicity
9. Observe patient for signs and symptoms of bleeding such as easy bruising, bleeding in the gums, and nosebleed.
10. Let the patient rest after taking the medicine or raise side rails up to ensure patient safety as this may cause
drowsiness.
 GENERIC NAME: DIGOXIN
BRAND NAME: N/A
CLASSIFICATION: CARDIAC GLYCOSIDE
DOSAGE AND FREQUENCY: 25mg OD (Daily)

ROUTE: PO

Increases force and velocity of myocardial contraction and prolongs refractory period of
atrioventricular (AV) node by increasing calcium entry into myocardial cells. Slows
MECHANISM OF ACTION: conduction through sinoatrial and AV nodes and produces antiarrhythmic effect

Treatment of patients with heart failure due to systolic dysfunction and for reduction of
INDICATION
the ventricular response in patients with atrial fibrillation or flutter. Digoxin may also be
indicated to treat other supraventricular arrhythmias, particularly with heart failure.

Digoxin is used to treat heart failure and abnormal heart rhythms (arrhythmias). It helps
DRUG RATIONALE
the heart work better and it helps control the heart rate.
 It is contraindicated in patients with:
- Uncontrolled ventricular arrhythmias
CONTRAINDICATIONS: - AV block Idiopathic hypertrophic
- subaortic stenosis
- Constrictive pericarditis

There are no side effects that are given in the case scenario but the possible side effects are:
COMMON SIDE
Fatigue, headache, asthenia bradycardia, ECG changes, arrhythmias blurred or yellow vision Nausea,
EFFECTS: vomiting, diarrhea, thrombocytopenia, decreased appetite

1. Apical pulse should be taken for a full minute before administration of this medication. If the apical
pulse is less than 60, the dose should be withhold and the prescribing provider notified.
2. Serum potassium levels should also be closely monitored for patients on digoxin, because
hypokalemia increases the effect of digoxin and can result in digoxin toxicity. Normal potassium level
is 3.5 to 5.5 mEq/L, and a result less than 3.5 should be immediately reported to the provider.
NURSING 3. Stay alert for hypocalcemia
CONSIDERATIONS: 4. Watch closely for hypokalemia and hypomagnesemia
5. Identify and report sign of toxicity such as yellow halos around lights.
6. In cases of vomiting, do not double the dose.
7. Prepare Digibind as an antidote in case of overdose to Digoxin.
8. Observe IV site for redness or infiltration; extravasation can lead to tissue irritation and sloughing
References:
● https://www.medicines.org.uk/emc/product/5290/smpc#gref
● https://www.ncbi.nlm.nih.gov/books/NBK430873/
● https://www.uclahealth.org/endocrine-center/normal-calcium-levels
● https://labtestsonline.org/tests/basic-metabolic-panel-bmp
● https://www.ncbi.nlm.nih.gov/books/NBK557839/
● https://www.rxlist.com/lasix-drug.htm
● https://go.drugbank.com/drugs/DB00695
● https://reference.medscape.com/drug/capoten-captoril-captopril-342315#10
Thank you!
Group 3 | NCMB312 RLE

Laberos, Faith
Landero, Janella Maegan
Lectana, Maica Balicat
Legson, Trina Faye
Lotino, Mikee Paluyo
Macaorao, Asnaira
Molina, Mariel-Ann
Naniong, Raiza Mae
Pactoranan, Kathleen Irish