Question

Case scenario:

Ms. Castro, a patient on the medical-surgical unit, was admitted 2 days before with a diagnosis of exacerbation of heart failure. This morning her BP is 175/80 mm Hg. She denies chest pain, but state that she has been experiencing shortness of breath. She tells the nurse she uses three pillows to be able to breathe at night while sleeping. Her baseline weight at admission was 170 lb, but this morning’s scale indicates a 4-lb weight gain, and +3 pitting edema to the lower extremities is evident. The nurse telephones the doctor and receives an order for furosemide 40 mg by mouth twice daily and metoprolol 25 mg PO daily to start immediately.

1. How will the nurse identify Ms. Castro prior to administering medications?
2. Which lab should the nurse review prior to administering furosemide and metoprolol?
3. The nurse scans the medication administration record (MAR), and administers the metoprolol. When she attempts to administer the furosemide, the patient states. “I don’t want the water pill”. What is the nurse’s next action?
4. What safety measures should the nurse use when administering the medication to MS. Castro?
5. What important information should the nurse document into MS. Castro’s medical record 30 minutes after administering the medication?

Answer 1

Heart failure:

The chronic inability of the heart to pump a sufficient amount of blood throughout the body leading to a pooling of blood and shortness of breath.  

1. Identification of Patient: It important for a nurse to identify the right patient , before administering the medication. The nurse can identify Ms. Castro with his full name and identification number , social security number and phone number. The nurse can ask the patient  to state her name and date of birth for correctly identifying the patient.  

2. Metoprolol: The nurse has to check the apical pulse before administering the medication . If the heart rate is below 50 beats per minute, then do not give the medication to the patient, instead report to the Doctor.  

Furosemide : The nurse has to check electrolyte level , decreased potassium, sodium, calcium and magnesium   level have to report to the Doctor.  

3. Furosemide is a diuretic used in the treatment of Congestive heart failure and edema.

The nurse can respond to the patient in a polite way . She can tell her " I respect your autonomy for accepting or rejecting the medication . But before that I want you to know the benefits of Furosemide. Furosemide increases the urination , by removing the excess water and sodium from the body. During a Heart failure, water may retain in the pleural space due to increased work load for the heart and increased pulmonary and systemic venous pressure. That inturn causes the shortness of breath . Furosemide removes this excess water and makes your breathing easy and you may feel better affter administering the pill. If you take a correct dose and have an intake of food and water according to the instructions , then you may not get any side effects from the drug.

4. Safety measures before administering the drugs:

The nurse has to correctly identify the patient and check his vital signs and necessary lab tests.

* If the pulse is below 50 bpm , then withdraw the medication and report to doctors.

* If there is a significant reduction in the electrolyte level ( hyponatremia, hypokalemia, hypocalcemia) , immediately report to Doctor before administering the medications.  

* Check the renal and hepatic lab test for any impairment in function.

* Ensure the five rights of Medication administration; Right drug, Right patient, Right time , Right dose and Right route.  

5. Patient's record: After medication administration, the nurse have to immediately record it in the patient's file. After 15 to 30  minutes she has to monitor the Electrocardiogram ( ECG) and vital signs . Record it . Mention if any abnormalities round. Also record intake and output ratio.