CHAPTER 22-29 CARDIVASCULAR DRUG PROJECT

1. A 49 year old man has been admitted to the hospital with severe congestive heart failure.
The physician plans to digitalize him and start maintenance therapy. Prepare a teaching
plan for this patient.
LEARNING OUTCOMES:
Upon completion of the one on one teaching with the patient, the patient will be able to:
1. Describe the pathophysiology of congestive heart failure/ signs and symptoms of impending CHF
2. Describe the medications that will be used to decrease the symptoms as well as the possible
side effects and the importance of strictly adhering to the medication schedule
3. Signs and symptoms of digitalis toxicity, and what foods should be eaten to decrease the risk of
toxicity
4. Additional patient teaching on how to manage the diagnosis.

CONTENT INFORMATION
1. Congestive heart failure is the accumulation of blood and fluid in the organs and tissues
from impaired circulation. Signs and symptoms of impending CHF include weight gain,
ankle swelling, fatigue, and dyspnea.
2. Clients taking potassium-wasting diuretics should consume potassium-rich foods, such as
a. Potatoes, sweet potatoes, winter squash, tomatoes, tomato juice
b. Milk, yogurt
c. Dates, bananas, cantaloupes, orange juice, prunes, raisins, prune juice
d. Dry beans, peas, lentils
e. Peanut butter
f. Bran cereals
Reduce the use of salt to little to none a day. Look for medications and foods that have
sodium (NSAIDS, for example.)
Take diuretics in the morning to decrease the chance of nocturia or disturbing the
patient’s sleep cycle.
3. Digoxin has a narrow therapeutic range. Signs of toxicity include bradycardia, fatigue,
green/yellow halo in the patient’s vision. Routine lab levels must be drawn. Potassium
levels must be routinely checked. High potassium increases the risk of digoxin toxicity.
4. Instruct the patient to weigh themselves daily, on the same scale, at the same time,
wearing the same clothes. Report a weight gain of 2.5 lbs/more a day. REPORT HEART
RATE OF <60, OR SYSTOLIC BLOOD PRESSURE <120. DO NOT ADMINISTER
DIGOXIN UNTIL APICAL HEART RATE IS TAKEN. DO NOT TAKE DIGOXIN IF
THE HEART RATE/BLOOD PRESSURE IS LESS THAN THE VALUES LISTED
ABOVE. Wear a medical bracelet.
TEACHING MATERIALS
1. Pamphlets
2. Face to face lecture, have the patient teach you the information that you explained to
them in their own words to show level of understanding and that the information given is
correct.
3. Educational videos
4. Additional resources such as reliable internet sources.
5. If applicable, have the patient’s family present when the teaching starts.

2. Mr. KS, a 53 year old social worker, has recently been diagnosed as having hypertension.
As you are caring for him, he tells you that he dislikes taking medications and plans to
discontinue his antihypertensive medication as soon as his blood pressure gets under
control. Develop a teaching plan for him.
LEARNING OUTCOMES:
1. Patient understands the importance of proper medication administration.
2. Patient understands signs and symptoms of worsening hypertension and organ
involvement. Also understands the additional management of the disease.
3. Patient confides in the nurse on why the medication is/is not working, and other possible
medications that can be used.
CONTENT INFORMATION:
1. Proper drug administration is vital in slowing down the disease process, as well as
deterring further damage and additional organ involvement. Prolonged hypertension puts
the patient at risk for kidney disease, stroke, increases retinal pressure.
2. Nonpharmalogical interventions include: weight management, smoking cessation (if
applicable), decreasing overall sodium intake, and moderate daily exercise. Signs and
symptoms of worsening symptoms include confusion, headache, visual disturbances.
3. Report systolic blood pressure >160 and diastolic pressure >115 IMMEDIATELY.
4. Always keep emergency drugs on hand, wear a medical bracelet.

TEACHING MATERIALS:
1. Try to have the patient’s family involved in the teaching.
2. Additional resources such as a print out of this teaching plan.
3. Refer the patient to a support group that involves people with the same diagnosis.
4. Lists of low sodium foods, as well as examples of other spices to use instead of salt.
 Mr. M.B. has been hospitalized for 2 weeks and is receiving IV heparin therapy for a severe
thrombophlebitis in his right thigh. The physician has just informed him that he will need to
take SC heparin at home. He wishes to learn to administer his own injections. Prepare a
teaching plan that includes the information he needs to know about his medication (injection
techniques and diet).

LEARNING OUTCOMES:
1. Patient understands the need for early ambulation as well as exercise.
2. Patient accurately demonstrates proper injection technique
3. Patient understands the diet that is needed.
4. Patient does not develop infection related to at home administration of heparin.
CONTENT INFORMATION:
Encourage older clients who are inactive to move every hour during the day to promote
circulation. Such movement is especially important during long car or airplane trips and can be
as simple as flexion and extension of the foot. Additionally, caution regarding prolonged
crossing of legs or ankles that can reduce circulatory flow.
 Take measures to prevent recurrences: avoid prolonged sitting and crossing the legs at the
knee, perform active movement, elevate the legs periodically, wear support hose, and
drink fluids liberally.
 Take long-term anticoagulant therapy exactly as prescribed.
 Keep appointments for the ordered laboratory tests to determine the effectiveness of
therapy.
 Watch for and report signs that indicate impaired clotting: nosebleeds, bleeding gums,
rectal bleeding, easy bruising, and prolonged oozing from minor cuts.
1. After cleansing hands and the skin, pinch the outer layer and inject the needle at a 45-90
degree angle.
2. If multiple injections are needed, rotate areas on the abdomen to prevent tissue damage.
3. Cover the injection site with an antiseptic swab post injection.
4. Offer smoking cessation instructions.
5. Maintain a low-fat diet and active lifestyle. (Plenty of plant foods, whole grain, reduced
fat dairy.)
TEACHING MATERIALS:
1. Refer to a nutritionist, if needed.
2. A powerpoint of different leg exercises to be done
3. If possible, have family present for patietn teaching.