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 Case 6- Heart Failure with Resulting Cardiac Cachexia 3. Left-sided heart failure occurs when the left side of the heart must work harder to pump the same amount of blood. The left ventricle supplies most of the heart's pumping power, so it's larger than the other chambers and essential for normal function. There are 2 types of L-sided failure: Systolic-the left ventricle loses ability to contract, and cannot push enough blood into circulation; Diastolic- left ventricle loses ability to relax normally to fill up with blood during resting period. With left-sided failure, blood gets backed up into the lungs and causes shortness of breath and fluid buildup.7 Right-sided failure usually occurs from left-sided failure as a result of increased fluid pressure. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver.135. Mrs. Maney is on fluid restriction because as a result of her heart not pumping enough blood due to heart failure, adding too much fluid to the body can cause unwanted symptoms such as swelling, weight gain, and shortness of breath. Getting rid of, or restricting fluid being consumed helps with treatment, because it takes pressure off of the heart to pump. Specific foods that are typically counted as fluid include soups, puddings, gelatin, ice cream, and popsicles.411. She would benefit from tube feeding because at the moment, she is not eating well due to shortness of breath and nausea. Enteral nutrition would be beneficial based on the guidelines that she is malnourished and unable to maintain safe oral intake. “Enteral feeding should be considered for malnourished patients or in those at risk of malnutrition who have a functional gastrointestinal tract but are unable to maintain an adequate or safe oral intake” 6Recommended formula: Jevity 42 mL/hr.= 1,012 mL/day 12. Lab Values Name of Lab Value Normal Value Pt’s Value & Date Reason for Abnormality Glucose70-99 mg/dL102 mg/dL (2/20) Glucose intolerance Bilirubin, total <1.2 mg/dL1.8 mg/dL (2/20)Morbidity/mortality Protein, total16-7.8 g/dL 5.5 g/dL (2/20)Inflammatory conditions LDL3<130 mg/dL 152 mg/dL (2/20)Plaque buildup in arteries HDL3 >59 mg/dL30 mg/dL (2/20)Plaque buildup in arteries CRP3<1 mg/L338 mg/L (2/20) inflammation/atherosclerosis RBC34.2-5.4 x 103/mm6 3.72 x 103/mm6 (2/20) Lack of oxygen in blood Hemoglobin312-16 g/dL 10.1 g/dL (2/20) Lack of oxygen in blood Hematocrit 37-47% 29 %(2/20) Low amount of oxygen being carried to blood Transferrin3 250-380 mg/dL 412 mg/dL (2/20) Lack of iron in the body 13. MedicationsDrug NameWhy is this medication prescribed for this patient?Should this medication be taken WITH or WITHOUT food?Any SIGNIFICANT nutritional concern with this drug?Lanoxin8 Help the heart beat stronger, with regular rhythm Stay hydrated With or without food -Can pass through breast milk -Frequent blood test should be done, especially kidney Aldactone2-Prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.-Treats edema/ fluid retention Do not drink alcohol With or without food -Can pass through breast milk -Avoid a high-salt diet-Do not use salt substitutes or low-sodium milk products that contain potassiumLasix9To prevent the body from absorbing too much salt Stay hydrated Alcohol can cause side effects -Will cause urination more often. -May need potassium supplementation. Lisinopril10To treat congestive heart failure in adults, or to improve survival after a heart attackWith or without food Alcohol can cause side effects -Do not use if you are pregnant-If you have diabetes, do not use lisinopril together with any medication that contains aliskiren -Do not use if you have kidney disease Lopressor11Slows down the heartbeat, helping the heart beat more regularly, and reducing the amount of work the heart has to doWith or without food Alcohol can cause side effects -Do not use nonprescription products that contain stimulants.-May cause low blood sugar -Can pass through breast milk Zocor14Lowers LDL cholesterol and triglycerides, and increases HDL cholesterol ; lowers risk of stroke and heart attack With or without food Avoid eating foods that are high in fat or cholesterolAvoid alcohol Avoid grapefruit -Grapefruit may interfere and cause dangerous side effects -Do not use when pregnant or breastfeeding Dopamine5Strengthens the heart and improves blood flow With or without food -Blood cells and kidney function may need to be tested oftenThiamin12Used to treat thiamine deficiency due to heart failure or taking Lasix With or without food -Do not use when breastfeeding References Albumin Levels Predict Survival in Patients With Systolic Heart Failure. Medscape. 2016. Available at: . Accessed November 28, 2016.Aldactone: Uses, Dosage & Side Effects - . Drugscom. 2016. Available at: . Accessed November 28, 2016.Blood tests for heart disease - Mayo Clinic. Mayoclinicorg. 2016. Available at: . Accessed November 28, 2016.Diuretics H. Heart failure - fluids and diuretics: MedlinePlus Medical Encyclopedia. Medlineplusgov. 2016. Available at: . Accessed November 28, 2016.Dopamine Injection: Uses, Dosage & Side Effects - . Drugscom. 2016. Available at: . Accessed November 28, 2016.Enteral Feeding. Enteral nutrition (EN) information. Patient | Patient. Patient. 2016. Available at: . Accessed November 28, 2016.Heart Failure. Healthline. 2016. Available at: . Accessed November 26, 2016.Lanoxin (digoxin) Uses, Dosage & Side Effects - . Drugscom. 2016. Available at: . Accessed November 28, 2016.Lasix: Uses, Dosage & Side Effects - . Drugscom. 2016. Available at: . Accessed November 28, 2016.Lisinopril: Drug Uses, Dosage & Side Effects - . Drugscom. 2016. Available at: . Accessed November 28, 2016.Lopressor HCT: Indications, Side Effects, Warnings - . Drugscom. 2016. Available at: . Accessed November 28, 2016.Thiamine medical facts from . Drugscom. 2016. Available at: . Accessed November 28, 2016.Types of Heart Failure. Heartorg. 2016. Available at: . Accessed November 26, 2016.Zocor: Uses, Dosage, Side Effects & Warnings - . Drugscom. 2016. Available at: . Accessed November 28, 2016. ................
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