Answer the following case study questions, missing information from…

Answer the following case study questions, missing information from Diuretic Worksheet, and all 3 patient scenario questions below:
Part I: AAA
Mr. Jensen has had a long recovery time after having a ruptured abdominal aortic aneurysm (AAA). He has been in the hospital for 4 weeks now after surgery. You have just assumed care of the patient and while awaiting report, look up the patient’s lab values. Labs show:
Total Protein- 5.0 gm/dl
Albumin- 2.6 gm/dl
Why might these lab values be low?
You get report from the night shift and go in to assess your patient. His weight is up 12 lbs since surgery and his blood pressure is trending around 98/56. The patient has just begun ambulating in the hall requiring a lot of assistance and encouragement. The patient has been advanced to a general diet but only eats 25% of each meal. The patient complains of stiff joints and feeling “tight”. He has 2+ pitting edema in dependent limbs.
Why does this patient have edema? What type of fluid shift is occurring?
What are some collaborative interventions to improve this patient’s nutrition?
What are some collaborative interventions to improve the patient’s edema?
The physician orders the patient to receive IV 25% albumin every 8 hours with IV Lasix to be given 30 minutes after albumin has infused.
What is the rationale for this order? What fluid shift will take place?
Part II: Diuretic Worksheet
Fill in the following grid:
Classification Generic Names/Trade Names Mechanism of Action Side Effects Nursing Considerations
Loop Diuretics
furosemide (Lasix)
torsemide (Demadex)
bumetanide (Bumex)
Thiazide Diuretics
hydroCHLOROthiazide (Urozide)
chlorothiazide (Diuril)
Chlorthalidone (Thalitone)
Potassium-Sparing
Diuretics
spironolactone (Aldactone, Carospir)
aMILoride (Midamor)
Patient Scenario 1:
F.M. has the following order on his MAR:
-furosemide (Lasix) 20mg BID IVP for bilateral lower extremity edema
The nurse assesses the following:
B/P 106/72 Weight 112.2 kg – down 0.5kg from previous day
HR 60 BUN 26
Lung sounds Diminished bilateral bases Creatinine 1.1
Edema +3 bilateral lower extremities Sodium 143
Urine Output 36 mL/hr Potassium 4
Is it safe to administer the medication? Why or why not?
How will the nurse know the medication was effective?
Patient Scenario 2:
A.L. has the following order on their MAR:
-hydrochlorothiazide (Urozide) 25 mg PO daily for HTN
The nurse assesses the following:
B/P 170/94 Weight 82 kg – up 3 kg since yesterday
HR 72 BUN 74
Lung sounds clear Creatinine 2.9
Edema No edema RLE, +2 to LLE Sodium 132
Urine Output 0 mL/hr Potassium 6
Is it safe to administer the medication? Why or why not?
How will the nurse know the medication was effective?
Patient Scenario 3:
C.R. has the following order on her MAR:
-spironolactone 100mg BID PO for pulmonary congestion
The nurse assesses the following:
B/P 96/60 Weight 102 kg – no change
HR 55 BUN 18
Lung sounds Crackles throughout Creatinine 0.9
Edema trace Sodium 139
Urine Output 40 mL/hr Potassium 5
Is it safe to administer the medication? Why or why not?
How will the nurse know the medication was effective?