Discussion Week 3: Stage A heart failure

Discussion Week 3: Stage A heart failure

Discussion Week 3: Stage A heart failure

ML is a retired registered nurse (RN) who has been given the diagnosis of Stage A heart failure. She knows from her RN education that she will definitely be placed on digoxin as a therapy. She remembers something about halos as something to be attuned to.

1. Explain the pathophysiology of Stage A heart failure. According to the American Heart Associate Stage A heart failure the patient is at a high risk for developing but the heart has not gone any structural changes. Our esteemed textbook by Woo and Robinson corresponds Stage A HF with the New York Heart association Class I heart failure. One thing of note is that Class I heart failure would have some asymptomatic left ventricle dysfunction. Regardless the three goals of therapy are improvement of symptoms, reduction in morbidity and reduction in mortality (Woo & Robinson, 2020)

. 2. What is the rational drug choice for treatment of this individual? The drug of choice would be ab Ace Inhibitor. The overreaching goal here is to reduce the preload/afterload thereby reducing stress on the heart and helping to prevent remodeling. They have been shown to improve symptoms, lower mortality and increase life expectancy in all populations. They reduce both preload and afterload and decrease heart remodeling. They are the only drug class to address all the pathological mechanisms of HF (Woo & Robinson, 2020). Therefore Lisinopril 2.5 mg daily would be prescribed. Increase by no more than 10 mg increments. Target dosing is usually in the 20 – 40 mg daily range (Lexicomp, 2017).

3. Address the patient’s concern about halos should digoxin be prescribed. While Digoxin is not a first line treatment for Stage A heart failure. Digoxin is most effective when Ejection Fraction (EF) is less than 40%. Halos are a sign of digoxin toxicity. Digoxin has a narrow therapeutic range of 1.0 to 2.0 ng/ml. Toxicity occurs in as many as 25% of patients. Digoxin half-life is 26- 48 hours and is cleared by kidneys. Renal function would an important consideration for dosing. Digoxin levels closely trend Creatinine levels. Digoxin must be used with caution with calcium channel blockers and diuretics. Patients K+ level also has to be monitored (Woo & Robinson, 2020).

4. Are there gender considerations related to medication treatment in this scenario? If so, what are they? For example, do men and women differ in their side effect profile and/or complications (for instance, from digoxin)? Discussion Week 3: Stage A heart failure

Gender differences play a role in HF because men and women have different symptoms. Women are more likely to delay seeking care heart disease symptoms than men. Women also have more complications, rehospitalizations, recurring cardiac events, and heart failure after a cardiac event than men. More women die within 5 years of an MI than men. Women are more likely to attribute Cardiac symptoms to other causes delaying care. Women tend to have atypical symptoms such as fatigue and nausea. One paradoxical finding was that women who tend to have higher health literacy rates than men had higher instances of misattribution of symptoms to non-cardiac causes. Men on the otherhand tend to have classic symptoms and have been trained by society to seek medical care when the present (Biddle, Fallavollita, Homish, Giovino & Orom, 2020). On the other end of the health literacy scale women with low health literacy rates tended to fair poorer. Low health literacy can lead to communication gaps with patients and doctors. Which in turn leads to lack of disease knowledge, inappropriate self‐care, and medication errors. Several studies have shown that this is especially true for women and HF. One-year hospital readmission rates are higher in women than in men and can be considered a predictor of negative outcomes for readmission and mortality in patients with HF. This may be attributed to lack of understanding of the symptoms (Son, & Won, 2020). On page 295 of our textbook it Woo & Robinson stated in 2020 Woo & Robinson state that “women fare worse on CGs” (digoxin) but they fail to elaborate (Woo & Robinson, 2020, p. 295). 5. Discuss monitoring of the pharmacological agent(s) selected. Monitor blood pressure, WBC values, weight change and fluid status. Creatinine levels should be monitored. For patients with renal impairment urine protein should be monitored before initiation of therapy and after dosage changes. (Woo & Robinson, 2020).

References Biddle, C., Fallavollita, J. A., Homish, G. G., Giovino, G. A., & Orom, H. (2020). Gender differences in symptom misattribution for coronary heart disease symptoms and intentions to seek health care. Women & Health, 60(4), 367–381. https://doi.org/10.1080/03630242.2019.1643817 Lexicomp. (2017). Drug information handbook for advanced practice nursing (17th ed.). Hudson, OH: Wolters Kluwer Clinical Drug Information. Son, Y., & Won, M. H. (2020). Gender differences in the impact of health literacy on hospital readmission among older heart failure patients: A prospective cohort study. Journal of Advanced Nursing (John Wiley & Sons, Inc.), 76(6), 1345–1354. https://doi.org/10.1111/jan.14328 Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.). Philadelphia, PA

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Discussion Week 3: Stage A heart failure

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