Medical Care Aov
Diuretics: chlorothiazide (Diuril), spironolactone (Aldactone) PO, which promotes fluid excretion by acting on the distal and proximal tubules or blocks action of aldosterone to decrease water, sodium chloride, and potassium absorption; furosemide (Lasix) PO or IV for acute failure, which acts to block reabsorption of water and sodium in the proximal, distal tubules and loop of Henle.
Cardiac Glycosides: digoxin (Lanoxin) tablets or elixir PO or IV form, depending on treatment, for acute or maintenance therapy to increase the force of and decrease the rate of cardiac contractions. Digoxin has a narrow therapeutic serum level of 0.8 to 2.0 g/L.
Angiotensin-Converting Enzyme (ACE) Inhibitors: captopril (Capoten), enalapril (Vasotec), PO to inhibit conversion of angiotensin I to II by reducing the production of renin; ultimately the result is to reduce vasoconstriction and aldosterone secretion, which lowers blood pressure and the work of the heart.
Electrolytes: potassium chloride tablet (Klorvess), elixir (Pan-Kloride) PO as a potassium replacement with use of diuretic therapy.
Humidified Oxygen: relaxes pulmonary vasculature and decreases cardiac workload.
Analgesics/Sedatives: morphine sulfate SC or IV to relax smooth muscle.
Chest X-ray: for cardiac dilatation and hypertrophy.
Electrocardiography: reveals ventricular hypertrophy and arrhythmias.
Echocardiography: for abnormal valve function via ultrasound.
Digoxin Level: for serum level, to prevent toxicity, and regulate dosage.
Electrolyte Panel: for hypokalemia caused by diuretics or hyperkalemia resulting from K+ supplements and/or Vasotec. May result in cardiac dysrhythmias.
Complete Blood Count: decreased Hgb and Hct in anemia.
Arterial Blood Gases: for decreased PO2 and pH and increased PCO2 leading to acidosis with pulmonary changes.
COMMON NURSING DIAGNOSES See DECREASED CARDIAC OUTPUT
Related to: Mechanical factors with alterations in (specify: preload, afterload, and inotropic changes in heart).
Defining Characteristics: (Specify: fatigue; oliguria; decreased peripheral pulses; pale, cool extremities; tachycardia; decreased BP; dyspnea, crackles.)
See INEFFECTIVE BREATHING PATTERN
Related to: Decreased lung expansion; pulmonary congestion.
Defining Characteristics: (Specify: dyspnea, tachypnea, orthopnea, cough, nasal flaring, respiratory depth changes, altered chest excursion, use of accessory muscles with retractions, abnormal arterial blood gases, wheezing, crackles, grunting, cyanosis.)
See FLUID VOLUME EXCESS
Related to: Compromised regulatory mechanisms.
Defining Characteristics: (Specify: edema [periorbital, peripheral], effusion, weight gain, dyspnea, orthopnea, crackles, blood pressure changes, oliguria, jugular vein distention, hepatomegaly, restlessness and anxiety, altered electrolytes, change in mental status.)
See IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS
Defining Characteristics: (Specify, e.g., percentage of meals eaten, weight loss, weight percentile, laboratory values.)
See RISK FOR DEFICIENT FLUID VOLUME
Related to: Medication (diuretics).
Defining Characteristics: (Specify, give values: output greater than intake, weight loss, hypokalemia, hypernatremia.)
See INEFFECTIVE TISSUE PERFUSION: CARDIOPULMONARY, PERIPHERAL
Related to: Hypervolemia, prolonged cardiac failure
Defining Characteristics: (Specify: edema, dyspnea, change in color, temperature of extremities [mottled, cold], decreased peripheral pulses, effusion, changes in BP (specify), tachypnea, orthopnea, tachycardia, cough.)
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