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I’m looking for additional feedback to compare on the following 2 scenarios. How would you respond to the questions below?

 

Part I: AAA

Mr. Jensen has had a long recovery time after having a ruptured abdominal aortic aneurysm (AAA).  He has been in the hospital for 4 weeks now after surgery.  You have just assumed care of the patient and while awaiting report, look up the patient’s lab values.  Labs show:

Total Protein- 5.0 gm/dl

Albumin- 2.6 gm/dl 

Why might these lab values be low?

You get report from the night shift and go in to assess your patient.  His weight is up 12 lbs since surgery and his blood pressure is trending around 98/56.  The patient has just begun ambulating in the hall requiring a lot of assistance and encouragement.  The patient has been advanced to a general diet but only eats 25% of each meal.  The patient complains of stiff joints and feeling “tight”.  He has 2+ pitting edema in dependent limbs.       

Why does this patient have edema?  What type of fluid shift is occurring?

 

 

What are some collaborative interventions to improve this patient’s nutrition?

 

 

What are some collaborative interventions to improve the patient’s edema?

 

 

 

The physician orders the patient to receive IV 25% albumin every 8 hours with IV Lasix to be given 30 minutes after albumin has infused.  

What is the rationale for this order?  What fluid shift will take place?

 

 

 

Part II: Diuretic Worksheet

Fill in the following grid:

Classification Generic Names/Trade Names Mechanism of Action Side Effects Nursing Considerations
Loop Diuretics

furosemide (Lasix)

torsemide (Demadex)

bumetanide (Bumex)

inhibits reabsorption of sodium and chloride. increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium.

Diuresis and susequent mobilization of excess fluid (edema, pleural effusion), decreased BP.

ERYTHEMA MULTIFORME, STEVENS JOHNSON SYMDROM, TOXIC EPIDERMAL NECROLYSIS, hypotension, hearing loss, tinnitus, dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovoemia, metabolic acidosis, increased BUN, excessive urination, muscle cramps, dizziness, headache, fever

Monitor I/O, daily wts, location of edema, lung sounds, skin turgor, mucous membranes

Monitor BP and P before and during administration

Monitor for falls w/elderly

Assess for n/v, muscle cramping, confusion, tinnitus, and hearing loss

Assess for allergy to sulfonamides

Assess for skin rash frequently during therapy, DC at first sign of rash. may be life threatening Stevens Johnsons Syndrome, toxic epidermal necrolysis, or erythema multiforme

Monitor labs

Thiazide Diuretics

hydroCHLOROthiazide (Urozide)

chlorothiazide (Diuril)

Chlorthalidone (Thalitone)

 increases excretion of sodium and water by inhibiting sodium reabsorption in distal tubule, promotes excretion of chloride, potassium, hydrogen, magnesium, phosphate, calsium, and bicarbonate, may produce arteriolar dilation.

Lowers BP in hypertensive patients and diuresis with mobilization of edema.

SKIN CANCER, STEVEN JOHNSON SYMDROME PANCREATITIS, dizziness, drowsiness, lethargy, weakness, hypotension, phtosensitivity, rash, acute angle closure glaucoma, hyperglycemia, hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia, cramping, hepatitis, n/v, muscle cramps, hypercholestremia, hyperuricemia

Monitor BP, I/O, daily wts; and assess feet, legs and sacral area for edema daily

Monitor labs (especially Potassium)–may need potassium supplementation or decrease dose of diuretic

Potassium-Sparing

Diuretics

spironolactone (Aldactone, Carospir)

aMILoride (Midamor)

 causes loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions by antagonizing aldosterone, directly inhibits testosterone secretion and androgen binding to androgen receptor.

Improved survival in patients  with NYHA class II-IV HF, weak diuretic and antihypertensive response when compared with other diuretics

DRUG RASH W/EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), STEVENS JOHNSON SYMDROME, TOXIC EPIDERMAL NECROLYSIS, alopecia, pruritis, amenorrhea, gynecomastia (in males), breast tenderness, deepening of voice, increased hair growth (in women), sexual dysfunction, hyperkalemia, hyponatremia, hyperchloremic metabilic acidosis, GI irritation, erectile dysfunction, dysuria, agranulocytosis, thrombocytopenia, muscle cramps, dizziness, clumsiness, headache, sedation

Monitor I/O ratios, daily weight

If medication is given as adjunct to antihypertensive therapy, evaluate BP before administration

Assess patient frequently for development of hyperkalemia (fatigue, muscle weakness, paresthesia, confusion, dyspnea, cardiac arrhythmias), esp patients with DM, kidney disease, and the elderly

Periodic ECGs in patients recieving prolonged therapy

Assess patient for skin rash frequently during therapy, D/C at first sign of rash (possible life-threatening Stevens Johnson Syndrome or toxic epidermal necrolysis)

Monitor labs

 

Patient Scenario 1:

F.M. has the following order on his MAR:

              -furosemide (Lasix) 20mg BID IVP for bilateral lower extremity edema

The nurse assesses the following:

B/P 106/72 Weight 112.2 kg – down 0.5kg from previous day
HR 60 BUN 26
Lung sounds Diminished bilateral bases Creatinine 1.1
Edema +3 bilateral lower extremities Sodium 143
Urine Output 36 mL/hr Potassium 4

 

Is it safe to administer the medication? Why or why not?

How will the nurse know the medication was effective?

 

Patient Scenario 2:

A.L. has the following order on their MAR:

              -hydrochlorothiazide (Urozide) 25 mg PO daily for HTN

The nurse assesses the following:

B/P 170/94 Weight 82 kg – up 3 kg since yesterday
HR 72 BUN 74
Lung sounds clear Creatinine 2.9
Edema No edema RLE, +2 to LLE Sodium 132
Urine Output 0 mL/hr Potassium 6

 

Is it safe to administer the medication? Why or why not?

 

How will the nurse know the medication was effective?

 

Patient Scenario 3:

C.R. has the following order on her MAR:

              -spironolactone 100mg BID PO for pulmonary congestion

The nurse assesses the following:

B/P 96/60 Weight 102 kg – no change
HR 55 BUN 18
Lung sounds Crackles throughout Creatinine 0.9
Edema trace Sodium 139
Urine Output 40 mL/hr Potassium 5

Is it safe to administer the medication? Why or why not?

How will the nurse know the medication was effective?

 

SCIENCE
HEALTH SCIENCE
NURSING
NURSING MISC

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