Reference no: EM133567539
Diuretic Case Study
An 80 year old woman has been taking spironolactone (Aldactone) 100 mg/day for about 6 years to control her moderate hypertension and mild HF. She comes to the ED with bilateral crackles in the lower and middle lobes and a BP of 190/120 mmHg. She is short of breath, very anxious, tachycardic (HR 134 beats/min), and diaphoretic. Her family assures you she has been taking her medication. The family tells you she has been getting worse over the past 2 weeks since having friends bring her favorite lunch of hot dogs and potato chips every day. She is diagnosed with pulmonary edema. Her orders are as follows:
Furosemide (Lasix) 40 mg IV push
Morphine sulfate 2mg IV push
Oxygen 3 L/min via nasal cannula
A basic metabolic panel (BMP)and complete blood count (CBC)
Place an indwelling foley catheter
1. Why has the physician ordered furosemide IVP rather than an oral form or another diuretic? How will this drug in this form help her current state?
2. What would be important for the nurse to know prior to administering the furosemide IV?
3. How will you know that the furosemide has worked (or at least started to work?)
Lab results, drawn prior to the furosemide, have returned. Her sodium is 140 (normal 135 to 145 mEq/L), chloride is 110 (normal: 98 -106 mEq/L), potassium is 3.5 (normal 3.5 -5 mEq/L). Knowing that she received her furosemide (Lasix) after these labs were obtained, what should the nurse be thinking about regarding changes to the above levels? What monitoring is needed?
The patient improves significantly within the first 6 hours. Her blood pressure is 138/90 mmHg, pulse 102, respirations 20 and crackles in the bases bilaterally. She asks you how this could have happened since she had been taking her medication as prescribed.
1. What should the nurse discuss with the patient as possible reasons for her condition?
2. What ongoing assessments need to occur at least daily while she is in the hospital?
The patient continues to improve and is being discharged home on furosemide (Lasix) 20 mg PO BID and spironolactone (Aldactone) 50 mg daily.
1. Why is the patient likely being prescribed two diuretics?
2. What education does the patient/family need regarding diet, monitoring, and signs/symptoms of further problems?