George Brown, 72 years of age, is a male patient who is admitted with the diagnosis of acute pulmonary edema secondary to acute left ventricular heart failure.

George Brown, 72 years of age, is a male patient who is admitted with the diagnosis of acute pulmonary edema secondary to acute left ventricular heart failure. The patient has a history of coronary artery disease that has been treated medically. The patient is anxious, pale, cold, clammy, and dyspneic. The vital signs are: blood pressure 88/50 mm Hg, heart rate 110 bpm, respiratory rate 32 breaths/min, and temperature 97°F. There are bubbling crackles and wheezing throughout the lung fields and the patient is raising frothy blood-tinged clear sputum. The patient’s admission weight is 100 kg.

a. What first actions should the nurse take and what are the rationales for these actions?

The physician ordered furosemide (Lasix) 40 mg IVP STAT.

b. What are the actions of furosemide that will help the patient?

c. What nursing actions should be implemented when administering a diuretic?

Solutions

Expert Solution

a Primary nursing goals include improving pumping of left ventricle and improve respiratory exchange .

Nursing interventions

Oxygen -nasal cannula,intubated or on respirator,PEEP decreases venous return by increasing intrathoracic pressure,will also improve oxygen,ABG and pulse oxymeter.

Inotropics-digoxin ,Dopamine and primacor which slow HR and improve contraction.

Morphine helps from anxiety,increases peripheral vasodilation,decrease venous return.

Administration of Diuretics.

Posotion-high Fowlers

Evaluationof patient.

Response

Report outcomes and revise plan.

bDiuretics such as lasix decrease the pressure caused by excess fluid in heart and lungs.

C Nursing interventions

Assess fluid status
Monitor daily weight,intake and output.
Monitor vital signs.
Assess the patient for skin rash.
Notify health care professional if thirst,drymouth,lethargy,weakness,hypotension or oliguria occurs

Nightingale answered 1 year ago

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