1. Adult Health Nursing II
Block 7.0
Topic: Cardiovascular Pharmacology
Module: 2.1

2. Cardiovascular Pharmacology
A Good Resource:
Block 7.0 Module 2.1

3. Concept Map: Selected Topics in Cardiovascular Nursing
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
Cardiac Monitoring
Lab Monitoring
PHARMACOLOGY
Cardiac Glycosides
ACE Inhibitors
Beta Blockers
Antiarrhythmics
Catecholamines
Anticoagulants
PATHOPHYSIOLOGY
Myocardial Infarction
Acute Coronary Syndrome
Valvular Heart Disease
Pacemakers
CABG
Abdominal Aortic Aneurysm
Pericarditis
Peripheral Vasc Disease (PVD)
Fem-Pop Bypass Graft
Shock / Fluid Deficit
Raynaud’s Phenomenon
Arrhythmias / Dysrhythmias
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary
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4. Potassium – Sparing / Combination Diuretics
Cardiovascular Pharmacology
Alpha
Blockers
Beta Blockers
Anti-Arrhythmics
ACE
Inhibitors
Anti-Hypertensives
Anti-Anginals
Digitalis Glycosides
Calcium Channel Blockers
Anti-Lipemics
Loop Diuretics
Potassium – Sparing / Combination Diuretics
Platelet Aggregation Inhibitors
Thiazide / Related Diuretics
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5. -pril------------------------------- ACE Inhibitor
-lol or –olol Beta Blocker
-pine  Ca Channel Blocker
-statin  anti-lipemic
-nitr  nitrates
-zosin  alpha blockers
-pine
-olol
-nitr
-statin
-lol
-pril
-zosin
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6. Alpha Blockers Beta Blockers Ca Channel Blockers ACE Inhibitors
atenolol (Tenormin ®)
carvedilol (Coreg ®)
metoprolol (Toprol XL ®, LoPressor ®)
propranolol HCl (Inderal ®)
Alpha Blockers
Beta Blockers
Ca Channel Blockers
ACE Inhibitors
Anti-Lipemic
Nitrates
-olol
-pril
-pine
-statin
-nitr-
-zosin
-lol
benazepril HCl (Lotensin ®)
captopril (Capoten®)
enalapril maleate (Vasotec®)
lisinopril (Prinivil ®, Zestril®)
amlodipine besylate (Norvasc ®)
diltiazem HCl (Cardizem ®, Dilacor ®)
nifedipine (Adalat ®, Procardia XL ®)
Verapamil HCl (Calan ®, Isoptim ®, Covera ®)
atorvastatin calcium (Lipitor ®)
lovastatin ( Mevacor ®)
pravastatin (Pravachol ®)
rosuvastatin calcium (Crestor ®)
simvastatin (Zocor ®)
isosorbide dinitrate (Isordil ®)
isosorbide mononitrate (Ismo®)
Nitroglycerin
doxazosin mesylate (Cardura®)
prazosin HCl (Minipress®)
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7. -pril ACE Inhibitors benazepril HCl (Lotensin ®) captopril (Capoten®)
enalapril maleate (Vasotec®)
lisinopril (Prinivil ®, Zestril®)
hypertension
CHF
Diabetic
Neuropathy
Left
Ventricular
Dysfunction
After MI
ACUTE M.I.
“The Multi-Purpose Group !”
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8. Prototype: captopril
ACE Inhibitors produce desired effect by blocking production of angiotensin II, resulting in arteriolar vasodilation, excretion of sodium and retention of potassium
Indications: Heart failure, HTN, MI (reduce mortality, reduce heart failure), diabetic & non-diabetic nephropathy.
Nursing Implications: orthostatic hypotension, cough, potential hyperkalemia
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9. The –pril’s: ACE Inhibitors
Treatment of Hypertension
captopril, enalapril, lisinopril—tx of HTN, CHF, decreased L ventricular function after MI
Always check BP before administering—hold PRN (parameters)
Teach patient to change positions slowly to avoid postural hypotension
“cough”
C.O. = HR x SV
BP = C.O. x PVR
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10. -zosin Alpha Blockers doxazosin mesylate (Cardura®)
prazosin HCl (Minipress®)
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11. Prototype: prazosin
Alpha blockers cause venous and arterial dilation, smooth muscle relaxation of prostate
Indications: HTN
Nursing Implications: monitor BP closely after initial dose; orthostatic hypotension
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12. The –zosin’s: Alpha Blockers sympatholytic
Uses:
Nursing Implications
Treatment of HTN
BPH (doxazosin (Cardura®)
Teach patient to avoid changing positions rapidly (postural hypotension)
Check blood pressure prior to administration; hold med PRN (Parameters)
C.O. = HR x SV
BP = C.O. x PVR
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13. -nitr- Anti-Anginals isosorbide dinitrate (Isordil ®)
isosorbide mononitrate (Ismo®)
Nitroglycerin
Nitro-dur®,
Transderm Nitro ®
Nitrol ®
Nitrostat ®
Nitrotab ®
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14. Prototype: nitroglycerin
Vasodilation of coronary artries increases myocardial oxygen supply; decreases myocardial oxygen demand via vasodilation and reduction of preload
Indications: angina treatment and/or prophylaxis;
Nursing Implications: hypotension, orthostatic hypotension, cough, potential hyperkalemia
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15. The –”NITR’s” Anti-Anginals (effect: vasodilation)
nitroglycerin sl, nitropaste, nitroderm
Chest pain regimen: 1 tab NTG sl, q5 min X 3
Isosorbide dinatrate (Isordil®)
Treatment / Prophylaxis of angina, CHF
C.O. = HR x SV
BP = C.O. x PVR
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16. Anti-Arrhythmics ( Anti-Dysrhythmics )
amiodarone HCl (Cordarone ®, Pacerone® )
lidocaine HCl (Xylocaine ®)
procainamide (Procanbid ®, Pronestyl ®)
quinidine (Quinaglute ®)
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17. Prototype: lidocaine
Class Ib antiarrhythmic; decreases electrical conduction, decreases automaticity, increases rate of repolarization
Indications: short-term use for ventricular dysrhythmias; monitor respirations—respiratory arrest. Cardiac monitor—vital signs
Nursing Implications: CNS effects—drowsiness, altered mental status, paresthesias, seizures
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18. A “Slight” Side-Effect of IV Amiodarone !
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19. Lidocaine HCl—the old reliable; used for PVC’s, ventricular ectopy, ventricular tachycardia
Amiodarone –Management of life-threatening ventricular arrhythmias unresponsive to less toxic meds; assess for pulmonary toxicity
Both of these: Infusion pumps, monitor v.s. frequently, cardiac monitor
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20. Anti-Hypertensives
clonidine (Catapres ®, Catapres Patch ®, Catapres TTS ®)
hydralazine HCl (Apresoline ®)
hydroclorothiazide / lisinopril (Prinzide ®, Zestoretic ®)
minoxidil (Loniten ®)
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21. Prototype: clonidine
Sympatholytic—decreases HR causes decrease in C.O., peripheral vasodilation—decreases BP
Indications: HTN, severe cancer pain
Nursing Implications: hypotension, orthostatic hypotension, administer twice daily in divided dose
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22. Hydralazine—tx of essential hypertension
HCTZ/Lisinopril—combination drug –essential hypertension
Always check BP prior to administration—hold PRN (Parameters)
Postural hypotension precautions
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23. -statin Anti-Lipemics atorvastatin calcium (Lipitor ®)
colestipol (Colestid ®)
gemfibrozol (Lopid ®)
lovastatin ( Mevacor ®)
Niacin ( Niacor ®, Niaspan ®)
nicotinic acid (Slo-Niacin ®, Vitamin B)
pravastatin (Pravachol ®)
rosuvastatin calcium (Crestor ®)
simvastatin (Zocor ®)
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24. Prototype: atorvastatin
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25. -lol -olol Beta Blockers atenolol (Tenormin ®) carvedilol (Coreg ®)
metoprolol (Toprol XL ®, LoPressor ®)
propranolol HCl (Inderal ®)
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26. Prototype: metoprolol
Remember that there are cardioselective and non-selective Beta blockers; Beta1 adrenergic blockage to reduce heart (- chronotrope) rate, decrease myocardial contractility (-inotrope), decrease rate of conduction through the AV node
Indications: angina, HTN, dysrhythmias, MI, Heart failure,
Nursing Implications: Apical pulse; monitor VS;
Contraindicated in AV Block, SB.
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27. Used for tx of HTN, MI, angina prophylaxis, CHF
Cardioselective vs nonselective B-Blockers and Respiratory
Nursing: Apical Pulse
C.O. = HR x SV
BP = C.O. x PVR
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28. Calcium Channel Blockers
-pine
Calcium Channel Blockers
amlodipine besylate (Norvasc ®)
diltiazem HCl (Cardizem ®, Dilacor ®, Tiamate ®, Cardizem SR ®, Cardizem CD ® )
nifedipine (Adalat ®, Procardia XL ®)
Verapamil HCl (Calan ®, Isoptim ®, Covera ®)
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29. Prototype: nifedipine
Vasodilation of peripheral arterioles; clocking of CA+ channels in heart causes decreased force of contraction, decreased heart rate, decreased pulse. (-inotrope, -chronotrope)
Indications: HTN, angina, selected dysrhythmias
Nursing Implications: hypotension, orthostatic hypotension, cardiac monitor, monitor pulse rate
Contraindications: AV blocks, hypotension, bradycardia, aortic stenosis, severe heart failure
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30. Nursing: Check BP, hold PRN (Parameters)
Treatment of HTN, vasospastic angina, angina prophylaxis, Atrial Fibrillation (sometimes) , rapid atrial dysrhythmias
Nursing: Check BP, hold PRN (Parameters)
Postural Hypotension Precautions
C.O. = HR x SV
BP = C.O. x PVR
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31. Digitalis Glycosides digoxin (Lanoxin ®) (+) Inotrope, (-) Chronotrope
CHF, Atrial Tachy-arrhythmias (A-Fib, A-Flutter), Cardiogenic Shock
Assess Apical Pulse
Dig Toxicity—anorexia, fatigue, weakness, yellow-green halo’s around lights
Role of K+ ! (Can be Dig Toxic with therapeutic Dig levels if K+ is low!) Therapeutic Level = ng/ml
Low K+: Possible U Waves on EKG
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32. Prototype: digoxin
(+) inotropic effect; (-) chronotropic effect; improves stroke volume and C.O.
Indications: treatment of heart failure; treatment of atrial fibrillation
Nursing Implications: AP, monitor dig levels, monitor K+
Contraindicated: Ventricular rhythm disturbances: VF, VT, 2nd -3rd degree AV block
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33. Loop Diuretics bumetanide (Bumex ®) furosemide (Lasix ®)
Monitor serum K+ 3.5 – 5.0 mEq/L
Potassium rich foods
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34. Prototype: furosemide
Block reabsorption of NA and Cl, prevent reabsorption of H2O, causing extensive diuresis;
Indications: Pulmonary edema d/t Heart failure
Nursing Implications: I&O, daily weights, hypotension, diuresis (foley?), orthostatic hypotension, monitor K+, RELATE THIS MED IN RELATION TO OTHER MEDS. Dietary counseling.
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35. Platelet Aggregation Inhibitors
clopidogrel bisulfate (Plavix ®)
dipyridamole (Persantine ®)
ticlopidine HCl (Ticlid ®)
Prevention of TIA’s, CVA; combined with warfarin or ASA for heart valves, MI, bypass grafts, stents.
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36. Prototype: aspirin Prevent platelets from clumping or aggregating;
Indications: Primary prevention of MI; prevention of CVA (stroke);
Nursing Implications: bleeding , GI Upset ; use cautiously in those with anticoagulants and NSAID’s (potentiates).
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37. Potassium Sparing / Combination Diuretics
hydrochlorothizide / triamterene
(Dyazide ®, Maxzide ®)
spironolactone (Aldactone ®)
Treatment of edema and hypertension
Avoid high K= foods (oranges, bananas, salt substitute, dried apricots, dates,
Weigh Daily
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38. Prototype: spironolactone
Spironolactone is classified as a potassium-sparing diuretic.
Indications:congestive heart failure, cirrhosis of the liver, and kidney disease. It can also be used in combination with other drugs to treat elevated blood pressure.
Nursing Implications: Used with other diuretics; Give with meals; Avoid salt substitutes containing potassium;
Monitor I and O
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39. Thiazides / Related Diuretics
chlorthalidone
(Hygroton ®, Hylidone ®, Thalitone ®
hydrochlorothiazide [hctz] (Hydrodiuril ®)
indapamide (Lozol ®)
metolazone (Zaroxylyn ®)
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40. Monitor for hypokalemia
NOTE THAT MORE THAN ONE HYPERTENSIVE –SOMETIMES SEVERAL--MAY BE NEEDED TO CONTROL HTN; USED IN COMBINATION WITH DIURETICS; Tx edema, HTN
Monitor for hypokalemia
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41. Anti-Coagulants Heparin Enoxaparin Warfarin Antidotes:
Heparin = protamine sulfate
Coumadin = vitamin K
Digoxin = Digibind, Digifab,
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42. Prototype: heparin
Inactivation of thrombin formation vis inhibition of fibrin formation,
Indications: DIC, stroke, prophylaxis agains post-op DVT,
Nursing Implications: bleeding (remember: internal & external bleeding) Heparin Induced Throbocytopenia (HIT)—stop if platelets <100,000; monitor aPTT (< 2 x baseline)
Antidote: Protamine sulfate
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43. Thrombolytic Medications
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44. Prototype: streptokinase
Act by dissolving clots.
Indications: Acute MI; DVT; Pulmonary emboli, ischemic stroke (alteplase)
Nursing Implications: MONITOR FOR BLEEDING; monitor VS; (see p. 310, ATI Pharm)
Contraindications: prior intracranial hemorrhage, active internal bleeding, significant trauma within 3 months, acute pericarditis, brain tumors.
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45. EMERGENCY
CARDIAC
PHARMACOLOGY
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46. Lidocaine (or amiodarone)
Oxygen
Epinephrine
Atropine
Adenosine
Lidocaine (or amiodarone)
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47. Block 7.0 Module 2.1

48. Oxygen
100 % ! (during resuscitation, for all clients, including those with chronic respiratory conditions, e.g., COPD)
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49. Epinephrine (Adrenaline) catecholamine
Pharmacologic action: vasoconstriction; increased heart rate (+ chronotrope); increased rate of conduction; increased BP; increased myocardial contractility.
Indication: Cardiac arrest; ventricular fibrillation
Administration: IV, IV push
Dose: 1 mg IV push  q3-5min
Nursing Implications: Monitor blood pressure, peripheral pulses, urinary output Use infusion pump
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50. Atropine sympathomimetics
Pharmacologic Action:
Indication: SYMPTOMATIC BRADYCARDIA
Administration: IV
Nursing Considerations: weigh the risks to increased myocardial oxygen demand in CV patient
1 mg rapid IV. Repeat q3-5 minutes up to maximum total dose of 0.04 mg/kg.
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51. Adenosine class V antiarrhythmic
Pharmacologic Action: Class V anti-arrhythmic; causes transient heart block in the AV node
Indication: SVT & WPW
Administration: IV Bolus
Nursing Considerations: after IV bolus, causes a transient asystole
6 mg rapid IV, followed by saline flush. If no response in 1-2 minutes give 12 mg rapid IV. May repeat in 1-2 minutes if needed.
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52. Lidocaine anti-arrhythmic
Indications: ventricular fibrillation, ventricular tachycardia
Pharmacologic Actions: anti-arrhythmic
Administration: IV
Nursing Considerations: monitor the patient! If received bolus, needs to receive a continuous infusion afterwards; CNS effects—drowsiness, altered mental status, seizures
1 to 1.5 mg/kg q3-5min. Maximum total: 3 mg/kg.
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53. Amiodarone anti-arrhythmic
Indications:
Pharmacologic Actions:
Administration:
Nursing Considerations:
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54. Matching C J S V A G D H K Y E L I M N O U B T F R X P Z W Q Column A
Column B
Alpha Blocker
Beta Blocker
Calcium Channel Blocker
Anti-Anginal
Anti-Arrhythmic
Anti-Hypertensive
Anti-Lipemic
Digitalis Glycosides
Loop Diuretics
Platelet Aggregation Inhibitors
Potassium Sparing / Combination Diuretics
Thiazide Diuretics
A. isosorbide dinitrate (Isordil ®)
B. digoxin (Lanoxin ® )
C. prazosin HCl (Minipres ®)
D. amiodarone HCl (Cordarone®, Pacerone ® )
E. hydralazine HCl (Apresoline ®)
F. dipyridamole (Persantine ®)
G. nitroglycerin (Nitrostat ®)
H. lidocaine HCl (Xylocaine ®)
I. simvastatin (Zocor ®)
J. doxazosin mesylate (Cardura®)
K. quinidine (Quinaglute ®)
L. clonidine (Catapres ®)
M. atorvastatin calcium (Lipitor ®)
N. gemfibrozol (Lopid ®)
O. lovastatin ( Mevacor ®)
P. spironolactone (Aldactone ®)
Q. hydrochlorothiazide [hctz] (Hydrodiuril ®)
R. clopidogrel bisulfate (Plavix ®)
S. carvedilol (Coreg ®)
T. furosemide (Lasix ®)
U. colestipol (Colestid ®)
V. propranolol HCl (Inderal ®)
W. nifedipine (Adalat ®, Procardia XL ®)
X. ticlopidine HCl (Ticlid®)
Y. verapamil HCl (Calan ®)
Z bumetanide (Bumex ®)
ACE Inhibitors C J S V A G D H K Y E L I M N O U B T F R X P Z
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55. Appendix: Electrolytes & Imbalances related to: Cardiac Effects
Sodium (Na+)
Effects:
Normal level =
135 to 145 mEq/L (adult)
Required in acid-base and osmotic pressure balance, nerve function and water equilibrium. 
>Decreased  Hypotension, headache, nausea, vomiting, abdominal cramps, muscle tremors, twitching, fatigue, headache, nausea, vomiting, diarrhea, abdominal cramps, muscle tremors, twitching, weakness, confusion, seizures, and coma
<Increased  Lethargy, irritability, muscle twitching, tremors, dry skin and mucous membranes, fever, hypotension, disorientation, delirium, cerebral hemorrhage, coma 
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56. ! Potassium (K+) Effects: Normal level = 3.5 to 5 mEq/L (adult)
Major factor in carbohydrate metabolism, osmotic pressure balance, acid-base balance and normal muscle contraction. 
> Decreased  Cardiac arrhythmia, depressed S-T segment, flattened/inverted T wave, U wave, confusion, lethargy, muscle weakness, paralysis, abdominal distention, constipation, paralytic ileus, thirst, frequent voiding
< Increased  Muscle weakness, paralysis, numbness and tingling, ventricular fibrillation, cardiac arrest, tall tented T waves !
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57. Effects Calcium (Ca++) Normal level = 8.5 to 10 mg/dL
>Decreased  Frequent hives, chronic fatigue, canker and cold sores, muscle cramps (Charlie Horses), and itchy skin dementia, depression, psychosis, tetany (Chvostek's and Trousseau's signs), laryngospasm, or generalized convulsions, cardiac arrhythmias with lengthened QT segments
<Increased  Muscle weakness, bone fragility, kidney stones, loss of appetite, thirst, frequent urination, lethargy, fatigue, joint pains, memory loss, depression, constipation, anorexia, nausea and vomiting, abdominal pain, ileus, polyuria, nocturia, and polydipsia, emotional lability, confusion, delirium, psychosis, stupor, coma, cardiac arrhythmias with shortened QT segment
Normal level =
8.5 to 10 mg/dL
Involved in bone and tooth formation, blood coagulation, nerve function, muscle contraction. 
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58. Magnesium (Mg2+) Normal level = 1.3 to 2.1 mEq/L
Required for activation of an enzyme necessary for energy metabolism and bone formation. 
>Decreased  Muscle weakness, fatigue, confusion, restlessness, hyperexcitability, vertigo, seizures, muscle tremors, nystagmus, tachycardia, hypotension, PAC, PVC, Toursades de Pointes arrhythmia, anorexia, nausea, vomiting, personality change, tetany (eg, positive Trousseau's or Chvostek's sign or spontaneous carpopedal spasm), and tremor and muscle fasciculations 
<Increased Muscle weakness, drowsiness, lethargy, hypotension, paralysis, coma, cardiac and respiratory problems
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59. Blood Glucose Hypoglycemia Hyperglycemia
Diabetic Ketoacidosis · Fatigue · Flushed, dry skin· Dry mouth · Increased thirst · Increased urination· Blurry vision · Headache· Nausea and Vomiting· Dehydration· Weak, rapid pulse· Hypotension· High blood glucose levels (>240 mg/dL).· Ketones in urine· Increased thirst and urination · Nausea, vomiting, and/or stomach pain· Changes in or difficulty breathing (Kussmaul’s respirations)· Acid or fruity smell on breath (Acetone breath)· Flushing · Dehydration · Fatigue · Stupor and coma
Restlessness· Irritability· Confusion· Trembling· Slurred speech · Headache · Tingling lips · Paresthesia· Diaphoresis (cool skin) · Pallor· Tachycardia· Shallow respirations· Hypertension· Weakness · Hunger · Coma · Tremors 
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60. Hypokalemia: ST depression, decreased or inverted T waves, U waves ²         Hyperkalemia: peaked T waves, decreased P waves, short QT, widened QRS, sine wave ²         Hypocalcemia: prolonged QT, flat or inverted T waves ²         Hypercalcemia: short or absent ST, decreased QTc interval ²         Hypomagnesemia: prolonged QT, flat T waves, prolonged PR, aFib, torsade ²         Hypermagnesemia: short PR, heart block, peaked T waves, widened QRS0 ²         Digitalis toxicity: ST depression (scoop), flat T waves ²         Quinidine: prolonged QT, widened QRS ²        Pericarditis: diffuse ST elevation with PR interval depression
Hypomagnesemia: prolonged QT, flat T waves, prolonged PR, aFib, torsade ²         Hypermagnesemia: short PR, heart block, peaked T waves, widened QRS0 ²         Digitalis toxicity: ST depression (scoop), flat T waves
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61. Appendix: A Med-Surg Nurses description of cardiac care—things to think about with patient care
Monitor your patient's response to drug therapy by assessing his blood pressure, heart rate, heart sounds, ECG results, breath sounds, urine output, and weight. Also, assess him for peripheral edema.
If the physician prescribes a digitalis glycoside, take your patient's apical pulse for a full minute before administering the drug. Withhold the drug if his apical pulse is less than 60 beats per minute.
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62. Begin digitalis glycoside therapy by administering a loading dose (AS ORDERED) to achieve a therapeutic level more quickly. Monitor your patient's serum digoxin level to ensure that it remains in the therapeutic range of 1 to 2 ng/ml. Also, assess him for signs and symptoms of digitalis toxicity.
If he's also receiving a thiazide or loop diuretic, monitor his serum potassium level; a low potassium level can lead to digitalis toxicity.
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63. If your patient is receiving one of these drugs during digitalis glycoside therapy, monitor his heart rate and rhythm and assess for signs of digitalis toxicity, such as gastrointestinal, neurologic, or vision disturbances. If he shows evidence of toxicity, HOLD THE MEDICATION & NOTIFY THE PYSICIAN--the digitalis glycoside will most likely be on hold until his level returns to the therapeutic range.
Other drugs that increase the risk of digitalis toxicity include beta-blockers, anticholinergics, quinidine, verapamil, nifedipine, amiodarone, and propafenone.
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64. After therapy, your patient may be referred to an occupational therapist to learn how to conserve oxygen and energy while performing daily activities. The therapist also may help your patient modify his environment to reduce cardiac workload. For ex­ample, the therapist may suggest moving bed­room furniture to the first floor and obtaining a bedside commode.
During therapy, reduce your patient's cardiac workload by restricting his activity. Provide oxygen through a face mask or nasal cannula, as prescribed, to support his heart's oxygen demands
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65. Tell him to withhold the dose and call the physician if his pulse is lower than 60 beats per minute. Also, teach him the signs and symptoms of digitalis toxicity, such as nausea, vomiting, diarrhea, fatigue, vision changes, and an abnormally slow pulse rate; hypokalemia, such as weakness, fatigue, nausea, abdominal cramps, and diarrhea; and hyperkalemia, such as muscle tenderness, fatigue, and constipation.
Teach your patient and his family about his prescribed drug therapy. If a digitalis glycoside has been prescribed, instruct him to take his pulse before taking the drug. Tell your patient that he may need potassium supplements with diuretic and digitalis glycoside therapy.
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66. Tell your patient that he may need potassium supplements with diuretic and digitalis glycoside therapy.
If your patient is taking more than one drug, help him devise a dosage schedule that accommodates his lifestyle. For example, advise him to take twice-daily drugs before breakfast and dinner (if not contraindicated) to avoid forgetting to take them during a busy workday.
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67. Instruct the patient to follow a low-sodium diet
Instruct the patient to follow a low-sodium diet. If necessary, refer him to a dietitian. Tell him to record his daily weights in a log and to report a weight gain greater than 3 pounds over 2 days or less.
Tell him to conserve his energy by resting frequently. Explain how to obtain and use supplemental oxygen, if prescribed.
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68. Most patients with heart failure benefit from a home care referral
Most patients with heart failure benefit from a home care referral. If your patient will have a home care nurse, tell him that the nurse will perform a complete assessment of his cardiac and respiratory status. And the nurse will answer questions about his drug regimen and monitor his compliance with the drug regimen and dietary restrictions.
The home health nurse will also instruct him and his family about using home oxygen therapy, if prescribed.
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