Stage B Heart Failure refers to a stage in the classification system of heart failure developed by the American College of Cardiology and the American Heart Association

QUESTION

Case Study:

Mrs. Swanson is a 76 year-old woman who has been treated for many decades for hypertension.

Case Study:

Mrs. Swanson is a 76-year-old woman who has been treated for many decades for hypertension.

She has been told that she has Stage B Heart Failure.

She has become increasingly tired while walking and doing housework.

A few hours ago, she awoke from a nap on the couch feeling “really winded.”

Q1: What is Stage B Heart Failure? Based on the information we have, does this patient still have Stage B Heart Failure?

This patient’s labs are as follows

BNP (basic natriuretic peptide) = 610 pg/mL (normal value for 76 y.o female < or = 140 pg/mL)

K+ = 5.4 mEq/L

BUN = 42 mg/dL

Creatinine = 2.0 mg/dL

Q2: Can you interpret these labs for your patient? Try to explain their significance in terms the patient can understand.

For BNP you can check take a look at this website from Mayo Clinic:

https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/83873

Q3: We are going to treat this patient with some medications. Do the labs have to be considered? Explain.

Your examination reveals that the patient has edema on the leg.

Q4: Relate what is going on to the patient’s heart failure. Explain to her why her legs look this way. The finding disappears several hours after the patient is admitted to the hospital. She’s been reclining in bed. Why?

Mrs. Swanson is taking Eplerenone 25mg tablet, Carvedilol 12.5 mg tablets, Enalapril Maleate 10 mg tablets, and Furosemide 40mg tablets.

Q5: List ONE adverse effect of each one of the medications.

Late on the first evening of admission Mrs. Swanson becomes increasingly short of breath. She is coughing and has low O2 sats on pulse oximetry. Her chest X-ray test was performed, and the chest radiograph shows an enlarged cardiac silhouette and edema at the lung bases, signs of acute heart failure.

Q6: Which medication would the nurse expect to administer to treat the condition seen (give the route)?

Q7: How quickly would the medication you chose work?

Mrs. Swanson is discharged from the hospital after receiving aggressive diuresis for a day.

A year goes by. She has been taking her medications as instructed. She has been trying to get some exercise each day under instruction of her cardiologist. Despite complying carefully with her pharmacotherapy and adhering to a strict diet, she is becoming increasingly fatigued with exertion. She is having more episodes of cough and shortness of breath. The decision is made to start DIGOX (digoxin tablets) 125 mcg (0.125 mg).

Q8: Does the decision to start this medication make sense?

Q9: Why do blood levels of this medication need to be monitored carefully?

ANSWER

Q1: What is Stage B Heart Failure? Based on the information we have, does this patient still have Stage B Heart Failure?

Stage B Heart Failure refers to a stage in the classification system of heart failure developed by the American College of Cardiology and the American Heart Association. It signifies the presence of structural heart disease without current or prior symptoms of heart failure. In this case, the patient’s increasing fatigue, shortness of breath, and the recent episode of feeling “really winded” indicate the possible progression of heart failure symptoms. Therefore, it is plausible that the patient may no longer be in Stage B Heart Failure and could have transitioned to a symptomatic stage.

Q2: Can you interpret these labs for your patient? Try to explain their significance in terms the patient can understand.

The labs indicate the following:

BNP (basic natriuretic peptide) = 610 pg/mL: BNP is a hormone secreted by the heart in response to increased pressure and stress. Elevated levels suggest heart failure. In this case, the higher BNP level indicates that the heart is experiencing strain and may not be pumping efficiently.

K+ = 5.4 mEq/L: Potassium is an electrolyte essential for proper heart function. A level of 5.4 mEq/L is slightly elevated. Abnormal potassium levels can affect the heart’s electrical activity and may require monitoring or intervention.

BUN = 42 mg/dL: Blood Urea Nitrogen (BUN) is a measure of kidney function. An elevated BUN level suggests impaired kidney function, which can occur in heart failure due to decreased blood flow to the kidneys.

Creatinine = 2.0 mg/dL: Creatinine is another marker of kidney function. An elevated creatinine level indicates impaired kidney function. It is crucial to monitor kidney function as it can impact medication dosages and overall management of heart failure.

Q3: We are going to treat this patient with some medications. Do the labs have to be considered? Explain.

Yes, the labs need to be considered when prescribing medications for the patient. The elevated potassium level (K+ = 5.4 mEq/L) may influence the choice and dosage of certain medications, as some heart failure medications can affect potassium levels. Additionally, the impaired kidney function indicated by elevated BUN and creatinine levels may affect the dosing and selection of medications that are cleared by the kidneys. Therefore, the patient’s lab results should be taken into account to ensure appropriate medication management and prevent potential complications.

Q4: Relate what is going on to the patient’s heart failure. Explain to her why her legs look this way. The finding disappears several hours after the patient is admitted to the hospital. She’s been reclining in bed. Why?

The edema observed in the patient’s legs is directly related to her heart failure. In heart failure, the heart’s ability to pump blood efficiently is compromised, leading to fluid accumulation in the body. The fluid can accumulate in dependent areas, such as the legs, due to gravity. This results in swelling, or edema, of the legs.

When the patient is admitted to the hospital and reclines in bed, the effect of gravity is reduced, allowing the accumulated fluid in the legs to redistribute throughout the body. As a result, the edema in the legs diminishes. However, when the patient resumes an upright position, such as standing or walking, the fluid can accumulate again, causing the reappearance of leg edema.

Q5: List ONE adverse effect of each one of the medications.

Eplerenone: Hyperkalemia (elevated potassium levels)
Carvedilol: Bradycardia (slow heart rate) or hypotension (low blood pressure)
Enalapril Maleate: Dry cough or hypotension
Furosemide: Dehydration or electrolyte imbalances

Q6: Which medication would the nurse expect to administer to treat the condition seen (give the route)?

Based on the patient’s symptoms of acute heart failure, the nurse would expect to administer Furosemide. Furosemide is a diuretic medication used to reduce fluid overload and relieve symptoms of congestion in heart failure patients. It is commonly administered intravenously (IV) to provide a rapid diuretic effect.

Q7: How quickly would the medication you chose work?

Furosemide, when administered intravenously, typically starts working within minutes to induce diuresis. The diuretic effect of Furosemide helps reduce fluid overload and alleviate symptoms of congestion, such as shortness of breath and edema.

Q8: Does the decision to start this medication make sense?

Yes, the decision to start Digoxin (digoxin tablets) for the patient’s increasing symptoms of fatigue, cough, and shortness of breath is appropriate. Digoxin is a medication commonly used in heart failure to improve symptoms, increase exercise tolerance, and reduce hospitalizations. It helps strengthen the heart’s contractions and regulate the heart rhythm, relieving some of the symptoms associated with heart failure.

Q9: Why do blood levels of this medication need to be monitored carefully?

Blood levels of Digoxin need to be monitored carefully due to its narrow therapeutic index. The therapeutic range for Digoxin is relatively small, and levels above or below the desired range can result in toxicity or lack of therapeutic effect, respectively. Regular monitoring ensures that the medication is maintained at a safe and effective level, minimizing the risk of adverse effects and optimizing its benefits in managing heart failure symptoms.