The GP tells Molly that there are more things she wants to discuss but needs to ensure she gets home safely today. Molly is happy to go home so the GP books her a taxi and books her an appointment for the next day.
| Findings | Linked to Molly’s heart failure | Outcomes |
|---|---|---|
| Review medications | May be worsening Molly’s HF e.g. pioglitazone and any non steroidal anti-inflammatories (NSAID) | Timely review of medications and alternatives as may affect other co-morbidities |
| BP 90/60(sitting) 80/50 (standing) |
Dizziness is worse when standing | Split timing of diuretic and beta-blocker. Advised to rise slowly to improve dizziness |
| Pulse 66 and regular | Molly is on multiple medications which can affect pulse rate and rhythm | Rationalise medications – see next screen |
| NYHA class III – (see Additional Information) | NYHA class is deteriorating as she has increased breathlessness and oedema | Diuretic compliance. Incontinence issues explored |
| Routine blood tests | Molly’s symptoms could be linked to worsening blood results | Await results in meantime discuss fluid and dietary intake |
Pulse point
What would you consider to be the important things to change for Molly today and what is may wait?
Important points are;
- Stop her pioglitazone and Ibrufen tablets are these can exacerbate her heart failure symptoms.
May or have the potential to etc
- Adjusting the timing of her beta blockers and diuretics may help her hypotension which can cause poor perfusion of her organ. This may improve her renal function. She is also at risk of dizziness and falls.
- Ask Molly if she actually taking the water pills in light of urinary incontinence? Inform her that she can alter the timing of diuretic to suit her daily activities.
- Advise Molly to reduce her fluid intake which includes fluid and food such as soups and puddings. Explain to her that there is not much point in taking the water pills if override them by taking in too much, especially as she is a diabetic and may feel thirsty.
- Discuss methods on how to reduce her thirst->low salt diet, low sugar, convenience foods etc.
Other points to be discussed:
- Look at Molly’s medication to ensure that there are no other contra indications with her tablets.
- Await her blood test results and adjust her medication if required
- Educate Molly on the importance of monitoring her fluid intake and weight management.
Page last reviewed: 28 Jul 2020
