Question

1. HYPERVOLEMIA

Assignment:

A patient was admitted in the medical ward with chief complaints of shortness of breath. Further assessment reveals the following findings:

BP – 140/90 mm Hg

HR – 111 bpm

RR – 24 cpm

+2 bipedal edema

Bibasilar crackles upon auscultation

The doctor initially ordered furosemide 20 mg ampule TIV every 8 hours and the following laboratory tests: Complete Blood Count (CBC), Serum Sodium, Serum Potassium, Blood Urea Nitrogen, Serum Creatinine, Total Protein, and Chest Xray.

1. Create a hypothetical FDAR.

2. What laboratory test may give the hint to the doctor about the oncotic

pressure of the patient?

Answer:

3. Create a drug study for FUROSEMIDE specifying the following:

1. Drug classification

2. Mechanism of action

3. Indication (*for the case of the patient mentioned above)

4. Contraindication

5. Side effects

6. Nursing Considerations

2. HYPOVOLEMIA

Assignment:

A teenage patient was rushed to the emergency department due to wrist

laceration from a suicide attempt. The patient is lethargic and have the following

findings upon assessment:

BP – 80/50 mm Hg

HR – 110 bpm

RR – 25 bpmThe doctor initially ordered fluid resuscitation with PNSS 1L, to fast-drip 200 cc

then the remaining fluid to run for 6 hours. Stat blood typing was ordered, and 3

units of whole blood was ordered to be transfused immediately after proper

cross-matching. The patient was hooked to oxygen 8 liters per minute via face

mask.

1. What parameters will the nurse check while the patient is undergoing rapid

fluid resuscitation?

2. For a patient who will undergo blood transfusion, enumerate the steps that

the nurse should prudently undertake while performing the procedure.

3. Create a hypothetical FDAR.

3. THIRD SPACE EDEMA

Assignment:

A patient with portal hypertension secondary to chronic liver cirrhosis was

admitted in the surgical ward. The patient presented with emaciated body build,

distended abdomen with prominent veins, and jaundice. The doctor ordered

paracentesis and the following laboratory tests prior the procedure: Prothrombin

time (PT), Activated Partial Thromboplastin Time (APTT), Total Protein, Albumin

Globulin ratio, AST, ALT.

1. Create a hypothetical FDAR for the patient.

2. Why is there a need to check the PT and APTT levels of the patient prior

paracentesis?

3. What is the rationale behind the order of checking the Total Protein, Albumin

Globulin ratio?

4. Enumerate the following regarding the nursing role in assisting with

paracentesis:

a. Position of choice

b. Site of insertion

Answer 1

1. HYPERVOLEMIA

FDAR chartting is used to document the patient data in a simple and easy way.

F- Focus; It stands for the problem identified or verbalised by the patient. D- Data; Document the assessment findings which support the patient problem A- Action; Here need to document the interventions done to solve the patient problem R- Response; In response patient is reassessed after some time and document the result of the interventions. Whether the patient improved or deteriorated

Date&time	Focus	Data, Action& Response
6/9/2020	Shortness of breath	D- Complaints of shortness of breath BP- 140/90 mm Hg, HR-111 bpm, RR- 24 cpm Auscultation- Bibasilar crackles Pedal edema - Grade +2 A- Provide semi fowlers position to ease breathing. Administer furosemide 20 mg tiv as per order. Start oxygen if SpO2 below 94% . Elevate footend to enhance venous return. Provide psychological support to reduce anxiety. R- Patient verbalizes comfort and easy breathing, RR-16 and on auscultation bilaterally normal breath sounds.

2. Oncotic Pressure

Oncotic pressure simply means pressure exerted by the colloids in a solution. In medical terms, Oncotic pressure is defined as, the pressure exerted by the proteins (albumin) in a blood vessel to displace the water molecules. The decreased oncotic pressure results in edema . Hypoprotenemia can resu;lt indecresed oncotic pressure. Therefore, total protein level can help the doctor to calculate osmotic pressure.

3. DRUG STUDY ON FUROSEMIDE

Drug Classification	Mechanism of action	Indication	Contraindication	Side effects	Nursing Considerations
Furosemide Loop Diuretics	Loop diuretics , acts in the thick ascending loop of Henle to increase the water loss from body. They inhibit the reabsorption of sodium in the kidney. It prevents the sodium-potassium-chloride co- transporter in the ascending limb of Henle's loop.	*Edema and Hypertension edeme associated with congestive heart failure >hypertensive crisis > Acute pulmonary edema >Hyperkalemia > hypermagnesemia	> Hypotension >Hypokalemia( Decreased potassium level in the blood) > Gout( excess uric acid in the blood) >Hypomagnesemia(decreased magnesium level in the blood)	> Increased urination, thirst and dry mouth are the most common side effects > Feeling of lightn headed, spinning sensation >Hypokalemia; pottasium is less than 3.1 mmol/l > Hyperurecemia > Dizziness > Rarely anaphylatic reactions > Head ache > Blurred vision	> Check Bp of the patient before administration > Inform the patient he may experience more urine output due to diuretic effect > Protect the medicine from light as it is phototoxic > Monitor daily weight of the patient > Monitor intake and output ratio > Monitor electrolytes level of the patient, it may cause decreased serum potassium, sodium, magnesium.