Question

1. HYPERVOLEMIA

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 X-ray.

1. Write down three (3) prioritynursing diagnoses for the patient and create a hypothetical FDAR.
2. What laboratory test may give the hint to the doctor about the oncotic pressure of the patient?
3. Create a drug study for FUROSEMIDE specifying the following:
   1. Drug classification
   2. Mechanism ofaction
   3. Indication (*for the case of the patient mentioned above)
   4. Contraindication
   5. Side effects
   6. Nursing Considerations

2. HYPOVOLEMIA

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 bpm

The 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. List down three (3) priority nursing diagnoses for the patient and create a hypothetical FDAR.

3.THIRD SPACE EDEMA

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. List down two (2) nursing diagnoses and 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:

• Position of choice
• Site of insertion
• At least three (3) nursing considerations.

Answer 1

Greetings of the day!

Please write & submit 1 question (with subparts) at a time .Submit all other questions separately.

Answer:

1.

(1)

NURSING DIAGNOSIS

-Excess Fluid Volume related to compromised regulatory mechanism as evidenced by bipedal edema (2+)

-Ineffective Breathing Pattern related to pulmonary congestion as evidence by shortness of breath with activity with use of accessory muscles.

-Risk for decreased tissue perfusion secondary to decreased cardiac output related to pumonary congestion.

FDAR:

Date / Time	Focus	Data, Action, Response
2/9/2020,9AM	Shortness of breath	D: patient: "I am having difficulty in breathing" (crackles lung sound+) A: 30 degree semi fowler's position given. R: patient: "I feel better now"

(2) What laboratory test may give the hint to the doctor about the oncotic pressure of the patient?

Albumin and globulin ratio.

A serum total protein test measures the amount of albumin and globulin present in the serum portion of the blood:

• Albumin protein accounts for half of the total protein found in blood plasma. It regulates oncotic pressure in the plasma to prevent water from leaking out of the blood vessels.
• Globulin proteins vary in size, weight, and function. They are grouped by how they migrate on electrophoresis and include α1, α2, β and γ fractions. They include carrier proteins, enzymes, complement, and immunoglobulins (also called antibodies).

(3) FUROSEMIDE- DRUG STUDY

indications specific for the patient: pulmonary congestion, right heart failure, pitting edema, pulmonary hypertension