Case Study: Electrolyte Imbalance and Hypertension Treatment

Patient Background

ST, 64-years old patient, has heart failure (HF), which is being controlled with digoxin (Lanoxin), furosemide (Lasik),and a low sodium diet. She is taking potassium chloride (KCL) 20 mEq per day orally. Three days ago, ST had flulike symptoms such as anorexia, lethargy, and diarrhea. Her fluid and food intake was diminished. She refused to take the Kcl and stated that the drug makes her sick. She has been taking the digoxin and furosemide daily.

The nurse’s assessingment during the home visit includes poor skin turgor, poor muscle tone, irregular pulse rate, and decreased bowel sounds. The nurse obtained a blood sample for serum electrolytes; result indicated a blood sample for serum electrolytes; results indicated potassium 2.9mEq/L, sodium 137 mEq/L, and chloride 96 mEq/L

1.       List reference values for serum potassium, serum sodium, and serum chloride. Are ST`s electrolyte levels within normal range? Explain your answer?

2.       Match ST`s physical findings with the corresponding electrolyte imbalance.

3.       What are the reasons for the electrolyte imbalance?

4.       ST said she was not taking KCL because the drug makes her sick. What information can you give her concerning the administration of potassium?

5.        What is the effect of furosemide on digoxin when there is a potassium deficit? Explain your answer.

6.       Why should the nurse assess ST for digitalis toxicity? List the signs and symptoms of digitalis toxicity. ST was referred to the health care provider because of her serum potassium deficit and its effect on digoxin. A repeat serum potassium determination was taken and the result was administered over 4 hours.

7.       How many milliequivalents of KCL. Does this amount constitute an acceptable dosage?

8.       Why is important that the nurse monitor the rate of intravenous fluids containing potassium, the hourly urine output, and vital signs?

9.       Because of the low serum potassium level, what other electrolyte value should be checked? Explain your answer After ST`s serum electrolyte returned to normal, the health care provider instructed her to continue taking the prescribed kcl dosage daily with her other medications.

10.   ST asks why has to continue taking these drugs .What is the nurse`s best response?

11.    The nurse instructs ST to eat foods rich in potassium?

Critical Thinking Case Chapter 43

JQ. A 58 years old patient has been recently diagnosed with hypertension. His resting blood pressure is 158/92. He is prescribed hydrochlorothiazide 50 mg/day and told to eat foods rich in potassium.

Nurse's Assessment and Diagnosis

1.      How does hydrochlorothiazide differ from furosemide (Lasix)? What are their similarities and differences?

2.      Why is it necessary for JQ to eat foods rich in potassium when taking hydrochlorothiazide? Explain your answer.

3.      What are the nursing interventions that should be considered while JQ takes hydrochlorothiazide? After one month on hydrochlorothiazide therapy, JQ becomes weak and complains of nausea and vomiting. His muscles are “soft.” Serum potassium level is 3.3 mEq/L.JQ`s diuretic is changed to triamterene/ hydrochlorothiazide (Dyazide). Again, he is advised to eat foods rich in potassium.

4.      Explain the rationale for changing JQ`s diuretic.

5.      Should JQ receive a potassium supplement? Explain your answer.

6.      What nursing interventions should the nurse follow for JQ?

7.      What care plan should the nurse develop for JQ in relation to patient teaching?

8.      What medical follow-up care is needed for JQ?

Critical Thinking Case Study Chapter 44

GG, a 72- years-old African American patient, has heart failure and diabetes. Her vital signs are blood pressure 176/94, pulse 92, and respirations 30. Her medications include hydrochlorothiazide 50 mg/day, atenolol 50 mg/day, and digoxin 0.25 mg/day.

1.Why was hydrochlorothiazide prescribed for GG? Explain the effects of hydrochlorothiazide on blood pressure.

2. Abnormal electrolytes and other laboratory test results may occur when taking hydrochlorothiazide.

 Would the following serum electrolytes and other laboratory values be expected to increase or decrease?

A, Sodium

B. potassium

Calcium

D. Magnesium

E. glucose

F Uric acid

3. Why should GG`s blood glucose level be monitored while she is taking hydrochlorothiazide?

4. What effect may result when GG takes digoxin and hydrochlorothiazide together/ Explain your answer.

5.Atenolol is what type of antihypertensive? Would atenolol be effective in lowering GG`s blood pressure if given as the only antihypertensive drug? Explain your answer.

6. How effective is the combination of hydrochlorothiazide and atenolol for controlling GG`s blood pressure? Explain your answer.

7. When using a combination drug therapy to correct hypertension, would the dosage for each drug be the same? Explain your answer.

8. When abruptly discontinuing beta blockers for hypertension without the patient taking another antihypertensive, what might occur? Explain how adverse effects can be avoided.

GG`s  blood glucose is 229. Her drugs for controlling hypertension are changed to prazosin 10 mg tid. Her cholesterol and LDL are elevated. Her serum potassium level is 3.2 mEq/L

9.      Why were GG`s hydrochlorothiazide and atenolol discontinued? Explain your answer.

10.  10. What type of antihypertensive is prazosin? Explain the physiologic action of prazosin for lowering the blood pressure.

List of Questions and Interventions

11.   Does prazosin have an effect on the blood glucose level? What effect could prazosin have on GG1s abnormal lipid levels? Explain your answer. GG`s ankles have becomes edematous. Hydrochlorothiazide is prescribed

12.   Why was hydrochlorothiazide added again to the drug  regimen?

13.  Is the daily prazosin does within the safe therapeutic prescribed range for GG? Explain your answer.( You may refer to prototype Drug Chart 44-2)

14.  List the groups of antihypertensive drugs that can cause sodium and water retention.

Critical Thinking Case Study Chapter 45

TM, a 57-years-old man, has thrombophlebitis in the right lower leg. IV heparin, 5000 units by bolus, was given. Following the IV bolus, heparin 5000 units given subQ 96h was prescribed. Other therapeutic means to decrease pain and alleviate swelling and redness were also prescribed. An aPTT test was ordered.

1.      Was TM1s heparin order within the safe daily dosage range?

2.      What are the various methods for administering heparin?

3.      Why was an apt test ordered? How would you determine whether TM is within the desired range? Explain your answer.

After 5 days of heparin therapy, TM was prescribed warfarin( Coumadin) 5mg po daily. An INR test was ordered.

4.      What is the pharmacologic action of warfarin? Is the warfarin does with in the safe daily dosage? Explain Your answer.

5.      What are the half-life and proteon-binding for warfarin? If a patient takes a drug that is highly protein-bound, would there be a drug interaction? Explain your answer.

6.      Why was an INR ordered for TM? What is the desired range?

7.      What serious adverse reaction could result with prolonged use or large doses os warfarin?

8.      What patient teaching interventions should the nurse include? List 3 interventions.

9.      Months later, TM has hematemesis. What nursing action should be taken?

Critical Thinking Case Study Chapter 46

JH had a myocardial infraction ( MI) 3 years ago. HE was prescribed gemfibrozil(Lopid) 600 mg, twice daily, before meals. His cholesterol remained between 220 and 240 mg/dl, and his LDL was 140 mg/dl. His anticholosterol drug was changed to simvastatin ( Zocor) 20 mg/day in the evening.

1. How does simvastatin differ from gemfibrozil?

2. Why do you think JH`s cholesterol drug, gemfibrozil, was changed to simvastatin?

3. While JH is taking simvastatin, which group of serum levels should be monitored?

4 How lolg after JH took simvastatin should his cholesterol and lipoproteins be check?

5. What is the maximum does for simvastatin?

6. JH complains of muscle pain and muscle weakness. What might this indicate.

7. Could JH receive both gemfibrozil and simvastatin? Explain your answer

8 JH is on vacation and does not have enough simvastatin tablets. What should he do?