Keola Akana is a 70-year-old male with a history of heart failure

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the
medical-surgical unit early on Monday morning for medication adjustment, monitoring, and
cardiac rehabilitation. On assessment, the client is sitting in bed. He is complaining of headache,
fatigue, blurred vision, and yellow halos around the lights in the room. He is cooperative with all
interventions and answers all questions directly and completely. Lab results have just returned;
serum potassium and digoxin levels are not in the therapeutic range. The client is also complaining
of increasing shortness of breath on exertion and orthopnea over the past 2 weeks.
Past Medical History
• Hypertension
• High cholesterol
Physical examination findings
• Vital signs: BP 98/57 mmHg, Pulse 54/min irregular, RR 22/min and laboured, SaO2 92% on
2L O2 vis nasal cannula, Temp 36.9 0C
Respiratory
• shortness of breath on exertion
• No nasal flaring, use of accessory muscles.
• Chest with bibasilar crackles on auscultation
• Productive cough with white phlegm
• Orthopnea reported
Cardiac
• Slightly irregular; S1, S2 & S3. Managing with digoxin3Scenario adopted from Elsevier-modified & edited by Nazool Alli
Abdomen
• no abdominal distention
• bowel sounds present
Neck
• distended neck veins
• JVD with jugular venous pressure >4cm
• no bruits noted on auscultation
Extremities
• 2+ bilateral pre-tibial pitting edema and also in feet and ankles
• Palpable pedal pulses
Integumentary
• Pale, cool and clammy
• Slightly diaphoretic
Genitourinary
• nocturia (voiding more than once at night)
Laboratory Results
Tests Results Normal value
Red blood cell count 4.9 million/mm3 4.4 – 5.7 X 1012/L
White blood cell count 11.0 × 109 /L 4.0-10.0 × 109 /L
Troponin <0.01 μg/L < 0.01 μg/L
B-type natriuretic peptide
(BNP).
>400 pg/ml
HF very likely
<100 pg/ml
sodium 133 mmol/L 135-145 mmol/L
potassium 3.0 mmol/L 3.5-5.0 mmol/L
Digoxin level 3.2 ng/mL 0.6 – 1.2 ng/mL
**HF= Heart Failure4Scenario adopted from Elsevier-modified & edited by Nazool Alli
Diagnostic test
• Chest x-ray confirmed pulmonary congestion with cardiomegaly.
Cardiac monitor ECG rhythm
Admitting Diagnosis
Mr. Akana was admitted to the medical-surgical unit with congestive heart failure (CHF). On
admission he was ordered the following medications in addition to his usual routine scheduled
medications:
• atenolol (Tenormin®) 50 mg po OD.
• furosemide (Lasix®) 80mg IV BID
• digoxin (Lanoxin®) 0.25 mg po TID

7. Explain each medication in detail (indications for use, mechanism of action, and effects)
in treating Mr. Akana’s heart failure.