Mr Jones, is an 82 year old man who is a regular patient of Mt Thomas Hospital (an acute public hospital in
Melbourne). He presents to the emergency department (ED), after collapsing while shopping with his wife. He
has the following symptoms:
• shortness of breath and coughing;
• swollen ankles;
• collapse;
• nausea and vomiting;
• fatigue and agitation.
He has a past medical history of:
• myocardial infarction (MI) x 1
• hypertension
• atrial fibrillation.
You note that Mr Jones blood pressure (BP) is 90/45, his pulse is irregular with long pauses at a rate of 48 beats
per minute. His prescribed medications prior to this admission include the following:
• Digoxin 375 mcg once per day;
• Frusemide 80mg twice per day;
• Enalapril 10mg per day;
• Warfarin 6 mg per day.
The medical officer has requested a chest x-ray, 12-lead ECG and blood tests. The x-ray shows congestion in
the lower to middle lobes. The 12-lead ECG shows atrial fibrillation at a rate of 48 beats per minute and an old MI
(pathologic Q-waves in V1-V6).
Biochemistry results show the following:
Potassium 2.9 mmol/L (normal rage is: 3.5 to 5.0 mmol/L)
Digoxin 2.4 ng/mL (normal rage is: 0.6 to 1.3 ng/mL)
The Questions are:
What are the 2 likely medical diagnosis, provide rationale for answer?
I said congestive heart failure & digoxin toxic...Is that right?
Also Scenario Update
The doctor prescribes the following medications to be administered immediately:
Sodium Chloride 1000mls with 2 grams Potassium Chloride IV to be given over 8 hours;
Frusemide 40mg IV start.
Discuss your responsibilities as a registered nurse for the management of Mr Jones during administration of
Sodium Chloride 1000mls with 2 grams Potassium Chloride IV and Frusemide 40mg IV? Dot-point responses
are acceptable. e.g. baseline BP pre treatment.
I'm really struggling with this assignment. any help is greatly appreciated. Thank you
