7.12 Clinical Reasoning and Decision-Making Learning Activities V2

Peter, 89 years old, lives independently and manages his own care. As the home health nurse, you are visiting Peter to assess how he is managing with the new diagnosis of atrial fibrillation.  He tells you he also has gout that flares up occasionally, and he used to have hypertension. Your assessment of Peter includes: VS: 132/98 HR 86 irreg RR 14 b/min O2 sats 95% on room air. He is orientated x 3, good long-term memory, but has difficulty with remembering a few recent events. His gait is steady and uses a cane for support. His chest is clear throughout with good air entry to bases. No cough, no sputum, no SOB.   Bowel sounds x 4 quadrants.  Abdomen soft.  Voiding independently, states nocturia x 2.  Skin warm and dry, pitting edema +1 bilaterally to feet and ankles.

He shows you his pill organizer of his meds and his calendar for important events and appointments. He was recently started on Warfarin and Diltiazem.

Med profile:

• Atorvastatin 20 mg po once daily
• Warfarin 7.5 mg po once daily for the next 7 days.
• Diltiazem 180 mg po once a day
• Ramipril 5 mg po BID

Answer the following questions in relation to the case study.

The nurse reviews the med profile and considers the rationale for some of the meds.

1. How does diltiazem work to improve Peter’s cardiovascular health? select all that apply
   1. Slows the conduction through the AV node
   2. Increases the conduction through the AV node
   3. Primarily causes vendilation resulting in a lower blood pressure
   4. Causes vasodilation in the coronary arteries and vascular smooth muscle
2. The nurse is doing some health teaching about the CCB: diltiazem. True or False: The nurse states, “This med may cause a low blood pressure resulting in dizziness. You may experience swelling in your ankles but this is a common side effect.”
3. Peter has heard he will need blood work done while on the anticoagulant: Warfarin. What blood work is routinely done to ensure the client is appropriately anticoagulated and to prevent the risk of a stroke? How often will he need this blood work done?
4. What is important health teaching for a client while on the anticoagulant, warfarin?
5. Peter tells the nurse he has been on Atorvastatin for many years. The nurse notices Atorvastatin is in the morning slot of his pill organizer.  True or False: taking atorvastatin in the morning is the best time to take this med.
6. Peter states he has also been on the ACE inhibitor: ramipril for a few years for his high blood pressure. The nurse recognizes more health teaching is needed if he states:
   1. If I get a bad productive cough it is due to ramipril. I will need to see my prescriber.
   2. If I get persistent dry cough, I should see my prescriber.
   3. I need to still watch my salt intake to prevent a higher blood pressure.
   4. I know to avoid salt substitutes as they are high in potassium.
7. Furosemide is loop diuretic commonly prescribed for a number of health issues to eliminate excess fluid. What might be some adverse effects of Furosemide? Consider some common and more serious adverse effects.

Note: Answers to the Clinical Reasoning Activities and Critical Thinking questions can be found in the Chapter 7: Cardiovascular Medications Answer key – Fundamentals of Nursing Pharmacology – 2nd Canadian Edition section at the end of the book.