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CHF

  • Admission orders

    • Admit: Telemetry Floor
    • Diagnosis: Congestive Heart Failure
    • Condition: Guarded
    • Vital Signs:
      • On admit and q 4 hours
      • Orthostatic BP each morning.
    • Allergies:
    • Nursing:
      • Daily weights
      • Strict inputs and outputs (I/Os)
      • Oxygen prn to keep sat > 92%
    • Diet: 2 g Sodium Restriction, Heart Healthy Diet
    • Activity: Bedrest with Bathroom Privileges, Up Only with Assistance. Fall Precautions
    • Labs:
      • CBC, CMP, glc
      • cardiac enzymes
      • BNP
      • TSH
      • urinalysis
      • EKG, CXR, past echos
    • IV: Heparin Lock
    • Special: cardio consult
    • Medications:
      • Furosemide 80 mg IV now, then 60 mg IV bid
      • Lisinopril 10 mg PO bid
      • Digoxin 0.125 mg PO qd
      • Stop carvedilol while hospitalized
    • Call house officer
      • RR > 30, increasing O2 requirement, SBP < 95, urine output < 100 mL/h
  • Tx

    • firstline: loop diuretic (furosemide 40mg PO q8hr prn for edema) and ACEi (lisinopril 5mg PO qday)
    • later add: beta blocker (carvedilol 3.125mg PO qday, increase to 6.25mg PO bid if tolerated)
    • ARB if can't tolerate ACEi
    • consider echo for underlying cause

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