The goal of managing congestive heart failure is to eradicate or minimize those factors that precipitate the disease. It also aims to strengthen the heart to cope with stress and reduce sodium and water retention.
drugs
1. Diuretics
2. Cardiac glycosides
3. Mild hypnotics
4. Supplemental Electrolytes
5. Expectorants
1. Diuretics: Diuretics such as Chlorothiazide 0.5gm-2gm are given daily to help the body eliminate excess fluid and sodium stored in the tissues.
Examples of other diuretics that may be used include:
– Furosemide (Laxis) 40-80 mg daily
– Ethacrynic acid (Edecrin) 80-200 mg daily
– Hydrochlorothiazide (Esidrix, hydrodiuril) 25-100 mg daily
Nursing responsibilities during the administration of diuretics
Yo. Diuretics should be administered before noon to prevent nocturia.
ii. The patient should be informed that diuretics will cause him to urinate frequently and also in large amounts.
iii. Weigh the patient daily to ensure that weight loss is not rapid. Daily weight loss of 4 pounds or more is dangerous.
IV. Keep records of entries and exits. Make sure the patient is not dehydrated.
v. Observe the patient for signs of adverse reactions. Signs to look out for include muscle cramps, weakness, fatigue, confusion, dizziness, lightheadedness, bloating, sweating, anorexia, etc.
saw. Check the patient’s vital signs, especially BP, for signs of hypotension.
2. Cardiac glycosides: digitalis as Tab Digoxin (Lanoxin, Davoxin) 0.5 mg stat, then 0.25 mg tds. Digitalis helps the ventricles to contract effectively and empty their blood. They also help improve myocardial contraction and slow down the heart rate. A high dose of digitalis is usually given initially to build up a therapeutic amount of the drug in the body. This is known as digitization. This is followed by a minimal number of maintenance doses.
Examples of other Digitalis include:
Yo. Digitoxin – Digitizing dose = 1.2mg-1.5mg in divided doses
ii. Digitalis – Digitalization dose = 1-1.5 g in divided doses, maintenance dose is 0.1 – 0.2 g
iii. Gitalin (Gitaligin) – Digitizing dose = 4-6mg. The maintenance dose is 0.25 – 0.5 mg daily.
Nursing Responsibilities When Administering Digitalis
Yo. Be very careful when reading digitalis drug labels because all digitalis preparations have similar names but different strengths and dosages, eg, digitalis, digoxin, digitoxin.
ii. Take the patient’s apical pulse for a full minute, administer a dose of digitalis.
iii. Take careful note of the pulse rate and rhythm and record accordingly.
IV. The drug should be discontinued if the heart rate is very fast, below 60, or irregular. Tell the doctor.
v. Do not administer the drug if there are severe symptoms of digitalis toxicity.
3. Mild hypnotics: eg Amytal sodium may be given for the first 2-3 nights to help the patient sleep comfortably.
Tranquilizers/pain relievers may also be given to the patient to relieve anxiety and pain.
4. Expectorant: Expectorant is given to help the patient cough up sputum from the lungs. Expectorants containing substances capable of causing respiratory depression should be avoided so as not to worsen respiratory distress.
5. Electrolyte supplementation: Hypokalemia (usually a complication of potassium-lowering diuretics) is prevented by administration of potassium chloride. A liquid potassium supplement can be given, but it should be diluted in water or fruit juice before taking to minimize gastric irritation.