Question

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 X-

ray.

1. Write down three (3) priority nursing 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 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 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

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. 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:

a. Position of choice

b. Site of insertion

c. At least three (3) nursing considerations

Answer 1

Hypervolemia

Hypervolemia, also known as fluid overload, is the medical condition where there is too much fluid in the blood. The most common causes of hypervolemia include: heart failure, specifically of the right ventricle. cirrhosis, often caused by excess alcohol consumption or hepatitis. kidney failure, often caused by diabetes and other metabolic disorders.

1.ANS

Nursing diagnosis

1. Difficulty in breathing due to hypervolemia.

2. Bipedal edema due to fluid electrolyte imbalance

3. Risk for infection due to disease condition

FOCUS	PROGRESS NOTE
Difficulty in Breathing	D:- Patient complainted shortness of breath. A:-Provided semi fowler's position. Provided oxygen . R:-Patient's breathing and SPO2 improved.
Bipedal edema	D:- Patient complainted of edema on both pedals A:- Administered furosemide. R. Patient's edema relieved.
Anxiety	D:- Patient told that he is confused and anxious about disease condition. A:-Provided psychological support through councelling and health education. R:- Patient looks confident and comfort.

2.ANS

Serum Osmolality Tests are used as a measurement to determine the number of solutes present in the blood (serum). These tests are typically ordered to evaluate hyponatremia, which is generally a result of sodium lost in the excretion of urine or excess fluid in the bloodstream.

Proteins influence the colloid osmotic pressure.

Chest x-ray has been one of the most used tests to evaluate for hypervolemia. Radiographic sings of volume overload include dilated upper lobe vessels, cardiomegaly, interstitial edema, enlarged pulmonary artery, pleural effusion, alveolar edema, prominent superior vena cava, and Kerley lines.

3. ANS

FUROSEMIDE

Classification

Furosemide is a type of medicine called a diuretic.

Mechanism of action

Furosemide, like other loop diuretics, acts by inhibiting the luminal Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle, by binding to the chloride transport channel, thus causing sodium, chloride, and potassium loss in urine.

Indication

This drug is used to treat high blood pressure, heart failure and oedema (a build up of fluid in the body). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.

Furosemide is a "water pill" (diuretic) that causes you to make more urine. This helps your body get rid of extra water and salt.

Contra-indications

kidney problems, liver problems, inability to make urine, gout, lupus,

Side Effects

Dizziness, lightheadedness, headache, or blurred vision may occur as your body adjusts to the medication. This medication may cause a serious loss of body water (dehydration) and salt/minerals. Serious side effects: muscle cramps, weakness, unusual tiredness, confusion, severe dizziness, fainting, drowsiness, unusual dry mouth/thirst, nausea, vomiting, fast/irregular heartbeat.

Nursing considerations

• Assess fluid status.
• Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes.
• Notify if the patient feels thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.
• Monitor BP and pulse before and during administration.