A patient has heart failure. A recent echocardiogram reveals decreased compliance of the left ventricle and poor ventricular filling. The patient takes low-dose furosemide and an ACE inhibitor
The primary care NP sees the patient for a routine physical examination and notes a heart rate of 92 beats per minute and a blood pressure of 100/60 mm Hg. The NP should: a. order serum electrolytes.
b. obtain renal function tests.
c. consider prescribing a B-blocker.
d. call the patient's cardiologist to discuss adding digoxin to the patient's regimen.
A
Patients with diastolic heart failure are sensitive to fluid depletion, which can cause decreased preload and stroke volume. This patient has a rapid heart rate and a low blood pressure, which can indicate dehydration, so serum electrolytes should be obtained. Renal function tests are not indicated. B-Blockers are used in patients who are stable. Digoxin should not be used in patients with diastolic failure.
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