During the admission interview, the nurse makes a list of the ...

[OSWALD]

During the admission interview, the nurse makes a list of the medications M.G. took at home.
 
  Nursing Assessment: Medications Taken at Home
  Enalapril (Vasotec) 5 mg PO bid
  Pioglitazone (Actos) 45 mg PO every morning
  Furosemide (Lasix) 40 mg/day PO
  Potassium chloride 20 mEq/day PO
 
  Which of these medications may have contributed to M.G.'s HF? Explain.

Question 2

M.G., a frequent flier, is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, I just had to come to the hospital today because
 
  I can't catch my breath and my legs are as big as tree trunks. After further questioning, you learn that she is strictly following the fluid and salt restriction ordered during her last
  hospital admission. She reports gaining 1 to 2 pounds every day since her discharge.
 
  What error in teaching most likely occurred when M.G. was discharged 10 days ago?

[diana chang]

Answer to Question 1

Thiazolidinediones, such as pioglitazone, may increase the risk of HF and should not be used in
patients with symptoms of HF. They commonly cause peripheral edema and weight gain (which are
the result of both water retention and increased deposit of adipose tissue).

Answer to Question 2

A breakdown of successful communication occurred regarding when to call with early weight
gain. It is imperative that patients understand when to call their provider after being discharged
from the hospital for exacerbated HF. Comprehensive patient education starting at admission is
considered a standard of care and is mandated by The Joint Commission when care is provided to
hospitalized patients. The goal of the discharge treatment plan is to facilitate successful patient selfmanagement,
minimize symptoms, and prevent readmission.