Case Study Essay

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PART ONE Medical-Surgical Cases

1
1 Cardiovascular

Cardiovascular Disorders
Case Study 1 Heart Failure
Difficulty: Beginning
Setting: Emergency department, hospital
Index Words: heart failure (HF), cardiomyopathy, volume overload, quality of life

X Scenario

M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure
(HF). 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
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Increased urine output
Daily weight, looking for weight loss
Intake and output (I&O)
Decreased dependent edema
Decreased shortness of breath, diminished crackles in the bases of the lungs, decreased work of breathing, and decreased O2 demands
• Decreased jugular venous distention (JVD)

6. What laboratory tests should be ordered for M.G. related to the order for furosemide
(Lasix)? (Select all that apply.)
a. Magnesium level
b. Sodium level
2

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CHAPTER 1

c.
d.
e.
f.

CARDIOVASCULAR DISORDERS

CASE STUDY 1

Complete blood count (CBC)
Serum glucose levels
Potassium level
Coagulation studies

1 Cardiovascular

Answers: A, B, D, E
Furosemide is a potent diuretic, especially when given IVP, and may cause the loss of electrolytes such as magnesium, sodium, and potassium. These electrolytes will need to be supplemented if the levels are low. In addition, furosemide may increase serum glucose levels, which is an issue, considering that M.G. has diabetes. It is not necessary to monitor CBC or coagulation studies while on furosemide.

7. What is the purpose of the beta blocker carvedilol? It is given to:
a. increase the contractility of the heart
b. cause peripheral vasodilation
c. increase urine output
d. reduce cardiac

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