Question

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:

4. Drug classification
     •Mechanism ofaction
     •Indication (*for the case of the patient mentioned above)
     •Contraindicatio
     •Side effecects
     •Nursing Considerations

Answer 1

1) Three priority nursing diagnoses for the patient :-

- Shortness of breath related to the fluid accumulation in lungs as evidenced by crackles on auscultation.

- Tachycardia related to increased load on heart as evidenced by heart rate

- Hypervolemia related to disease condition( heart failure) as evidenced by +2 bipedal edema

FDAR - Focus , Data , Action and Response

Focus - Hypervolemia

Data - Pedal edema with +2 bipedal edema

Action - To give Furesomide

Response - Decrease in edema and increase in urine output

2) The laboratory test that will give the hint to the doctor about the oncotic pressure of the patient is Total protein in which the albumin levels will indicate about th oncotic pressure .

3) Drug study on Furesomide :-

#. Class :-

Diuretic

#. Action:-

Reduces edema and increase urinary output

#. Indication :-

Edema due to heart failure, hepatic impairment, or renal disease; hypertension

#. Side effects :-

Dehydration

Hypokalemia

Hypomagnisemia

Hypovolemia

Metabolic Acidosis

#. Contraindications:-

Hypersensitivity to furosemide or sulfonamide antibiotics, anuria, hepatic coma, or severe fluid or electrolyte depletion.

Patient teaching :-

-take as directed, take missed doses as soon as possible, do not double doses

- contact doctor of more than 3 pounds are gained in one day

- change positions slowly to minimize orthostatic hypotension

- sunscreen/ protective clothing to prevent photo sensitivity reactions

-contact Hc provider if taking OTC meds or herbal products with this therapy

#. Nursing implications :-

-monitor Bp

- assess fluid status

-Monitor I/o

-assess for tinnitus or hearing loss

- assess fall risks and implement fall prevention strategies