Jerry Stein, 76 years old, was hospitalized for complaints of increased shortnes

Question

Jerry Stein, 76 years old, was hospitalized for complaints of increased shortness of breath (SOB) and cough. He had noticed swelling around his ankles. On admission he had crackles mid-to base bilaterally. Labs reveal a BNP of 625. Mr Stein has a history of Type 1 diabetes mellitus. He was diagnosed with chronic heart failure (CHF). He was started on multidrug therapy and discharged. He returns to the outpatient clinic 10 days later complaining of blurry, yellowed vision, anorexia, nausea, and “just not feeling right.” Data obtained from the nursing assessment include the following:

• Mild, peripheral edema • Heart sounds normal, no S3

• Lung sounds have a few scattered crackles but are otherwise clear.

• Vital signs: temperature, 97.8°F; pulse, 54; respirations, 12; blood pressure, 140/90

• Allergies: Sulfa

The patient’s current medication therapy includes digoxin, 0.25 mg PO qd; hydrochlorothiazide, 25 mg PO qd; and captopril, 25 mg PO tid.

QUESTIONS:

Which findings from the nursing assessment demonstrate the effectiveness of drug therapy?

Which findings from the nursing assessment demonstrate possible adverse effects from drug therapy?

What changes, if any, would you anticipate in his drug therapy related to your assessment of the patient?

What teaching is required for Mr. Stein regarding his drug therapy? Do you need any additional data to determine appropriate teaching?

Explanation / Answer

The findings in nursing assessment which demonstrated the effectiveness of drug therapy are normal heart sounds, clear lungs, temperature, respiratory rate and blood pressure.

The possible adverse effects are,

The patient is allergic to sulfa drugs. Often sulfa drug allergies coexist with allergy to hydrochlorothiazide. Also, there is mild peripheral edema and blood pressure is in high normal range. Therefore, this drug can be replaced with another diuretic.

The teaching that is required for Mr. Stein iscthatvto explain him that his symptoms of disturbances in vision, anorexia and body pain is due to the effect of drugs.

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