Health Care Professionals of all types (Doctors, Nurses, Pharmacists.. etc.) Please help!! : )?

I am a nursing student and I have to do a case study for my pharmacology class. I have two questions which I am having a hard time figuring out. I will pose the Case and then ask you the 2 questions. Thank you for your help!!

75 year old admitted with increasing fatigue and ankle edeme (4+). She ha sbeen active until the past couple of weeks. She has persistent dyspnea especially at night. She has had less of an appetite. She has a history of an MI 5 years ago with chronic heart failure.

5'8 130 lbs
Rales in L lower lobes

Temp 97, 130/70, 30, 100
Na+- 131
K+- 3.8
BUN- 35
Creatinine- 1.6

Doctor's Orders:
Increase Benazepril to 40 mg/day
Furosemide 40 mg once per day
Continue Fosinopril
Add Digoxin 0.125 mg PO 1x/day


1) Why has the doctor decided to add Digoxin to her medication?

2) Why does the doctor not want her to increase her K+ intake?



I appreciate you taking the time out to help! : )

Thank you all so much! You're wonderful.. and so are your answers!!!

1. digoxin is because she is experiencing right sided heart failure secondary to left sided heart failure (proof that she has right failure is the ankle edema, proof of the left is the dyspnea at night because of pulmonary edema and the rales). so this med is added to increase force of contraction.

2. he should want to increase the K+ because he gave her a loop diuretic (furosemide), that is a potassium (K+) waster. maybe he just wants to monitor for now since her levels are normal for Na and K.

hope that helps!

2. Increase the K because Lasix is not a potassium-sparring diuretic.
I'm not sure about the first on probably because with the fluid overload there is more strain on the heart.

1) Digoxin will help strengthen and regulate her heartbeat, the dyspnea at night and rales could be signs of impending heart failure.

3) He K+ is within the normal perameters. She does not need to increase her intake of it.

The answer for question 2 is probably because too much potassium could complicate the MI. Too much can be dangerous. I don't know what to say for question 1. I took pharmacology, but never had questions like this.

I get the sense that she's been getting the lasix all along and her potassium value of 3.8 is fine. Her creatinine of 1.6 already shows renal failure and she's on two ACE inhibitors too; adding more potassium may not be a great idea unless she's documented as actually being in hypokalemia.

Though on Lasix, and it may have dropped some of her preload pressures (as she was active until a few weeks ago), she clearly has developed new signs of failure (rales and nocturnal dyspnea, severe dependent edema, tachypnea), so adding digoxin, a positive inotrope, is appropriate as it would augment her cardiac output. Increasing her Benazepril too, will hopefully drop her afterload resistance, and increase cardiac output. Thus, by allowing her heart to push harder against less resistance, this would increase perfusion of her kidneys allowing more fluid to be off loaded. I would add that the doctor should keep an eye on her sodium as she's borderline hyponatremia (which would further complicate her metabolic picture and worsen her fatigue).

Ralph