TY - CHAP M1 - Book, Section TI - Drugs Used in Heart Failure A1 - Jobst, Erin E. A1 - Panus, Peter C. A1 - Kruidering-Hall, Marieke Y1 - 2020 N1 - T2 - Pharmacology for the Physical Therapist, 2e AB - CASE STUDYT.S. is a 75-year-old man with heart failure resulting from longstanding cardiomyopathy. The patient has a history of coronary artery disease including a triple coronary artery bypass graft 5 years ago. He has a body mass index (BMI) of 30 kg/m2 and a 45-pack-year history of smoking, though he quit smoking 8 years ago. Ten days ago, T.S. had a right total knee arthroplasty and spent 3 days in the hospital and 5 days in a rehabilitation facility. He was discharged from the rehabilitation facility with minimal assistance for sit to stand transfers and household distance ambulation with a front-wheeled walker. He was referred to outpatient physical therapy to continue transfer and gait training and to increase his aerobic endurance. On initial evaluation, the physical therapist measured his blood pressure at 135/75 mm Hg and pulse at 68 bpm. His current drug list includes daily carvedilol, benazepril, furosemide, and spironolactone. In addition, he takes an opiate analgesic as needed for pain relief. The patient arrives this morning for his second therapy appointment. As T.S. walked with his front-wheeled walker approximately 15 ft from his car to the clinic, the therapist noted that he appeared pale. Before initiating the session, the therapist stated her observation and concern. T.S. said that he has consistently been taking all his drugs as prescribed on the preceding days. The therapist measured his blood pressure as 145/90 mm Hg for and pulse at 70 bpm. Prior to beginning gait training with a cane, the physical therapist notices that the patient’s legs appear significantly swollen. She assesses bilateral 3+/5 pitting edema at his ankles. T.S. shares that he had dinner last night at the new barbecue restaurant where he had a delicious barbecue platter with French fries and “bottomless” iced tea. Cautiously, the therapist assists T.S. to standing and begins gait training with the cane. After approximately 35 ft, T.S. becomes extremely dyspneic with audible wheezing and is diaphoretic around his head, neck, and hands. A chair is immediately brought up behind the patient and the therapist assists him to a seated position. His vital signs are 160/94 mm Hg and 86 bpm. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessphysiotherapy.mhmedical.com/content.aspx?aid=1192814310 ER -