Congestive Heart Failure

2. Diagnosis: Congestive Heart Failure

3. Condition:

4. Vital signs: q1h. Call physician if P >120; BP >150/100 <80/60; T >38.5°C; R >25, <10.

5. Activity: Bed rest with bedside commode.

6. Nursing: Daily weights, measure inputs and outputs. Head-of-bed at 45 degrees, legs elevated.

8. IV Fluids: Heparin lock with flush q shift.

9. Special Medications: -Oxygen 2-4 L/min by NC.

Diuretics:

-Furosemide 10-160 mg IV qd-bid or 20-80 mg PO qAM-bid [20,40,80 mg] OR

-Torsemide (Demadex) 10-40 mg IV or PO qd; max 200 mg/day [5, 10, 20, 100 mg] OR

-Bumetanide (Bumex) 0.5-1 mg IV q2-3h until response; then 0.5-1.0 mg IV

q8-24h (max 10 mg/d); or 0.5-2.0 mg PO qAM. -Metolazone (Zaroxolyn) 2.5-10 mg PO qd, max 20 mg/d; 30 min before loop diuretic [2.5,5,10 mg]. ACE Inhibitors:

-Quinapril (Accupril) 5-10 mg PO qd x 1 dose, then 20-80 mg PO qd in 1 to

2 divided doses [5,10,20,40 mg] OR -Lisinopril (Zestril, Prinivil) 5-40 mg PO qd [5,10,20,40 mg] OR -Benazepril (Lotensin) 10-40 mg PO qd, max 80 mg/d [5,10,20,40 mg] OR -Fosinopril (Monopril) 10-40 mg PO qd, max 80 mg/d [10,20 mg] OR -Ramipril (Altace) 2.5-10 mg PO qd, max 20 mg/d [1.25,2.5,5,10 mg]. -Captopril (Capoten) 6.25-50 mg PO q8h [12.5, 25,50,100 mg] OR -Enalapril (Vasotec) 1.25-5 mg slow IV push q6h or 2.5-20 mg PO bid [5,10,20 mg] OR

-Moexipril (Univasc) 7.5 mg PO qd x 1 dose, then 7.5-15 mg PO qd-bid [7.5, 15 mg tabs] OR

-Trandolapril (Mavik) 1 mg qd x 1 dose, then 2-4 mg qd [1, 2, 4 mg tabs]. Angiotensin-II Receptor Blockers:

-Irbesartan (Avapro) 150 mg qd, max 300 mg qd [75, 150, 300 mg]. -Losartan (Cozaar) 25-50 mg bid [25, 50 mg]. -Valsartan (Diovan) 80 mg qd; max 320 mg qd [80, 160 mg]. -Candesartan (Atacand) 8-16 mg qd-bid [4, 8, 16, 32 mg]. -Telmisartan (Micardis) 40-80 mg qd [40, 80 mg].

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