Name:______________________________________________________________Date: _____________

Section/Group: _____________________ Group Members: ____________________________________

INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point.
When asked to provide several answers, list them in order of priority or significance. Do not assume
information that is not provided.
Heart Failure Scenario:
M.G., a “frequent flier,” is admitted to the emergency department with a diagnosis of heart failure. She
was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the
hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further
questioning, you learn she is strictly following the fluid and salt restriction ordered during her last
hospital admission. She reports gaining 1 to 2 pounds every day since her discharge.
1. What error in teaching most likely occurred when M.G. was discharged 10 days ago?

Case Progress:
During the admission interview, the nurse makes a list of the medications M.G. took at home.
Nursing Assessment: Medications Taken at Home
Enalapril (Vasotec) 5 mg PO bid
Pioglitazone (Actos) 45 mg PO every morning
Furosemide (Lasix) 40 mg/day PO
Potassium chloride 20 mEq/day PO
2. Which of these medications may have contributed to M.G.'s heart failure? Explain.

3. Make a Drug study of the medications listed above.

After reviewing M.G.'s medications, the physician writes these medication orders:
Medication Orders Enalapril (Vasotec) 5 mg PO bid
Carvedilol (Coreg) 100 mg PO every morning
Glipizide (Glucotrol) 10 mg PO every morning
Furosemide (Lasix) 80 mg IV push (IVP) now, then 40 mg/day IVP
Potassium chloride (K-Dur) 20 mEq/day PO
4. What is the rationale for changing the route of the furosemide (Lasix)?

5. You administer furosemide (Lasix) 80 mg IVP. Identify three parameters you would use to monitor the

effectiveness of this medication.

6. What laboratory tests should be ordered for M.G. related to the order for furosemide (Lasix)?

7. What is the purpose of the beta blocker carvedilol?

CASE STUDY PROGRESS

The next day, M.G. has shown only slight improvement, and digoxin (Lanoxin) 125mcg PO daily is added

to her orders.

8. What is the action of the digoxin?

9. Which findings from M.G.'s assessment would indicate an increased possibility of digoxin toxicity?

Explain your answer.

10. M.G.'s symptoms improve with IV diuretics and the digoxin. She is placed back on oral furosemide
(Lasix) once her weight loss is deemed adequate to achieve a euvolemic state. What will determine
whether the oral dose will be adequate to consider her for discharge?

11. M.G. is ready for discharge. Using the mnemonic MAWDS, what key management concepts should
be taught to prevent relapse and another admission?
Name:______________________________________________________________Date: _____________
Section/Group: _____________________ Group Members: ____________________________________
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point.
When asked to provide several answers, list them in order of priority or significance. Do not assume
information that is not provided.
CAD Scenario:
You are a nurse at a freestanding cardiac prevention and rehabilitation center. Your new patient in risk-
factor modification is B.T., a 41-year-old traveling salesman, who is married and has three children. He
tells you that his work does not let him slow down.
During a recent evaluation for chest pain, he underwent a cardiac catheterization procedure that
showed moderate single-vessel disease with a 50% stenosis in the mid right coronary artery (RCA). He
was given a prescription for sublingual (SL) nitroglycerin (NTG), told how to use it, and referred to your
cardiac rehabilitation program for sessions of 3 days a week. B.T.'s wife comes along to help him with
healthy lifestyle changes. You take a nursing history, as indicated in the following.
Family History
Father died suddenly at age 42 of a myocardial infarction (MI)
Mother (still living) had a quadruple coronary artery bypass graft (CABG × 4) at age 52
Past History and Current Medications
Metoprolol (Lopressor) 25 mg PO every 12 hours
Aspirin (ASA) 325 mg per day PO
Simvastatin (Zocor) 20 mg PO every evening
Lifestyle Habits
Smokes an average of 1½ packs of cigarettes per day (PPD) for the past 20 years. Drinks an “occasional”
beer, and “a 6-pack every weekend when watching football”
Dietary history:
High in fried and fast foods because of his traveling
Exercise:
“I don't have time to take walks.”
General Assessment:
White Male Weight 235 lb Height 5 ft, 8 in.
Waist circumference 48 in.
Blood pressure 148/88 mm Hg
Pulse 82 beats/min
Respiratory rate 18 breaths/min
Temperature 36.9 ° C

1. There are several risk factors for coronary artery disease (CAD). For each risk factor listed, mark
whether it is nonmodifiable or modifiable.
a. Age d. Obesity
b. Smoking e. Physical inactivity
c. Family history of CAD f. Gender
g. Hypertension j. Ethnic background
h. Diabetes mellitus k. Stress
i. Hyperlipidemia l. Excessive alcohol use

Case Progress:
You review B.T.'s most recent lab results.
Laboratory Testing (Fasting)
Total cholesterol 240 mg/dL
HDL 35 mg/dL
LDL 112 mg/dL
Triglycerides 178 mg/dL

4. Which lab values are of concern currently? Explain your answers.

5. B.T. asks you, “So, how is my ‘good cholesterol’ doing today?” Which is considered the “good
cholesterol,” and why? What do his HDL and LDL levels indicate to you?

6. Identify health-related problems if he will stay on salt, sugar, fat, chocolate, and caffeine in his
diet.; the problem that is potentially life threatening should be listed first.

7. Of all of his behaviors, which one is the most significant in promoting cardiac disease?
8. What is the highest priority problem that you need to address with B.T.? How will you
determine this? Identify the teaching strategy you would use with him.

9. Create a HOME CARE checklist on B.T.