NSG-533 -Hypertension/Heart Failure Discussion

NSG-533 -Hypertension/Heart Failure Discussion

A patient diagnosed with moderate to severe left ventricular heart failure, which is classified as Stage C heart failure. The ejection fraction (EF), a measure of how well the heart pumps blood, is crucial here. Normally, EF falls between 55% to 70%, but in this case, it’s only 30%, which is dangerously low and life-threatening. This indicates heart failure with reduced ejection fraction, requiring adjustments to the current medication plan.

To improve symptoms by reducing fluid buildup in the body and easing breathing difficulties, we might consider increasing HCTZ to 25mg taken orally daily or adding furosemide at a dosage of 20-40 mg taken orally daily. Loop diuretics like furosemide are more effective for treating heart failure compared to thiazide diuretics like HCTZ.

It’s important for the patient to stop taking ibuprofen because it can interfere with the effectiveness of diuretics. Instead, Tylenol can be used for arthritic knee pain.

The current medication, verapamil, is not suitable for heart failure patients. It should be replaced with a more suitable medication like hydralazine, particularly for patients intolerant to ACE inhibitors due to renal issues.

Hydralazine and furosemide, when used long-term, don’t have adverse effects. However, regular monitoring is necessary, especially with HCTZ, which could potentially cause kidney issues.

In addition to medication adjustments, non-pharmacological recommendations are vital. These include weight loss, increased physical activity, and reduced sodium intake. If the patient smokes or drinks alcohol, quitting or reducing consumption is advisable.

Informing the patient about the diagnosis and the importance of these changes is crucial for effective management of heart failure and reducing hospital readmissions.

Furthermore, if the patient’s EF hasn’t improved above 35% after three months, referral for device therapy might be necessary. Oxygen therapy and ultrafiltration could also be considered based on the patient’s specific conditions and needs, especially if there’s documented hypoxemia or excess fluid and sodium retention.

– Chavey, W. E., Hogikyan, R. V., Harrison, R., & Nicklus, J. M. (2017). Heart failure due to reduced ejection fraction: Medical management.
– Shah, P., Pellieri, P., Cultbert, J., & Clark, A. L. (2017). Pharmacological and non-pharmacological treatment for decompensated heart failure: What is new?

Decreasing Blood Pressure in Overweight Patients with Hypertension

NSG-533 -Hypertension/Heart Failure Discussion

 The patient’s heart failure should be classified as moderate to severe, left ventricular heart failure (Stage C). The ejection fraction (EF) determines how well your heart is able to sufficiently pump blood.  The normal ejection fraction is 55%-70%.  An ejection fraction of 30% is deemed to be extremely low and life-threatening.  Based on her EF, she is having heart failure with reduced ejection fraction. There need to be adjustments made to the patient’s current medication regimen. I could either increase the HCTZ to 25mg PO daily or add furosemide of 20-40 mg PO daily because it is the more effective drug for heart failure.  The change will improve her symptoms by reducing the amount of fluid in her body, allowing her to breathe easier. Diuretics acting on the loop of Henle, are more effective for the treatment of heart failure than thiazide diuretics, acting on the distal tubule (Biondi-Zoccai et al, 2017). This will improve her symptoms of edema.  In the long-term taking HCTZ or furosemide.  The patient would have to discontinue the use of taking her ibuprofen because it is an NSAID and they are contraindicated because they can create sodium retention and reduce the effectiveness of diuretics.  I would inform her to take Tylenol for her arthritic knee pain.

The verapamil that the patient is currently taking is contraindicated in individuals with any degree of heart failure. I would discontinue that order and start her on a more conducive medication like hydralazine.  Vasodilators have been shown to reduce mortality in patients self-prescribed as African-Americans with NYHA class III-IV HFrEF.  They are also recommended to reduce morbidity and mortality in patients with current or prior symptomatic HFrEF who cannot be given ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency, unless contraindicated (Ghandi et al., 2017).  In the long-term, hydralazine and furosemide don’t have any long-term negative outcomes.  In order to monitor parameters for HCTZ, if prescribed could potentially cause kidney failure so I would advise her to have her levels checked every 6 months.  Also, with the use of Tylenol, I would recommend she only take the minimum dosage (no more than 3000mg daily) necessary to alleviate her knee pain in order to reduce hepatic toxicity.  I would also have her come back in 3 months following medication adjustments/changes to determine if her EF has improved.

There are a few non-pharmacological recommendations for this patient. The long-term goal of the treatment and management of heart failure is to avoid exacerbation of heart failure and to decrease the hospital readmission rate (Inamdar & Inamdar, 2016).  I would inform the patient of her new diagnosis to ensure she understands why these new changes are imperative.   I would recommend that she would attempt to lose weight because she is only 62 inches tall, but she weighs 139 lbs.  That equals a BMI of 25.42 which classifies her as being obese.  I would encourage her to increase her physical activity and reduce her sodium intake.  It is unclear if the patient smokes or consumes alcohol.  If she does, I would encourage her to reduce and/or stop smoking or drinking alcohol.


Biondi-Zoccai, G., Borges, A.R., Resende, E.S., & Roever, L. (2017).  Drugs used to treat heart

failure with reduced ejection fraction.  Current Trends in Cardiology, 1(1), 8-11.


Ghandi, D., Mansukhani, R., Shah, A., Shah, K.J., & Srivastava, S. (2017).  Heart failure: A

class review of pharmacotherapy.  Pharmacy and Therapeutics, 42(7), 464-472.

Inamdar, A. A. & Inamdar, A.C. (2016). Heart Failure: Diagnosis, management and utilization.

Journal of Clinical Medicine, 5(7), 62.


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  • Karen Halter

Nov 4, 2020 10:07 AM

Module X Response for Pharm

Carlita thank you for your post. One question I had was why you chose hydrolizine rather than an ACE medication for our unfortunate lady. Heart failure with poor EF results in high rates of morbidity and mortality and clinical trials indicate treatment with an ACEi medication demonstrates mortality benefit.(Chavey et al., 2017) Hydrolizine is recommended if she is intolerant of ACE inhibitors due to renal disease and is indicated for use as an adjunctive therapy. (Chavey et al., 2017) I agree with your follow-up in three months and if at that time her EF has not improved above 35% I would make a referral for device therapy, especially if her life expectancy is greater than one year. (Chavey et al., 2017)

I agree with all of your non-pharmacologic suggestions for our case study.  Because our lady is sleeping on pillows due to shortness of breath I did find some research on the use of oxygen, but only if the patient is suffering from documented hypoxemia. (Shah et al., 2017)The same research also mentioned the use of ultrafiltration to remove excess fluids and sodium which has shown improvement in symptoms. (Shah et al., 2017)


Chavey, W. E., Hogikyan, R. V., Harrison, R., & Nicklus, J. M. (2017). Heart failure due to reduced ejection fraction: Medical managementhttps://www.aafp.org/afp/2017/0101/p13.html

Shah, P., Pellieri, P., Cultbert, J., & Clark, A. L. (2017). Pharmacological and non-pharmacological treatment for decompensated heart failure: What is new? PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423987/