Question

A. A 60-year-old patient with extremely high blood pressure is prescribed nitroprusside as an emergency measure. You are required to monitor the patient’s response to the drug.

1. List and explain the important nursing interventions you will take?

B. Richard Morton is a 70-year-old African American man. He is admitted to the hospital for treatment of significant edema associated with heart failure. The physician has ordered furosemide (Lasix) IV 1 mg/kg every 6 hours.

1. If Mr. Morton weighs 150 pounds, how many milliliters should the nurse administer every 6 hours if furosemide (Lasix) is available in a 20-mg/mL vial?

2. During the administration of furosemide (Lasix), for what adverse reactions should the nurse observe Mr. Morton?

3. The use of furosemide (Lasix) can result in hypokalemia. How do you identify hypokalemia? What abnormalities will be expected in his lab results?

Answer 1

A)

Nitroprusside is a vasodilator. It dilates the blood vessels. This lowers blood pressure and allows. It is used to treat congestive heart failure and life-threatening hypertension.

Nursing Intervention

1) This drug has a very profound effect on hemodynamics thus it is recommended that patients on nitroprusside should have an arterial line to monitor blood pressure.

2) Monitor heart rate and blood pressure continuously

3) Monitor renal and hepatic function

4) Metabolic acidosis is the earliest and most reliable evidence of cyanide toxicity

5) Measure cyanide and thiocyanate blood levels every 6 hours if used for more than 24 hours patient has significant renal insufficiency, or dose is >4mcg/kg/min for any period of time.

6) Protect solution from light. Cover bag and tubing during infusion.

7) Monitor for methemoglobinemia. Methemoglobinemia decreases the blood’s oxygen carrying capacity. This should be suspected if the patient has received more than 10 mg/kg of sodium nitroprusside. Methemoglobin levels are measured in the laboratory.

8) Monitor for hypothyroidism. Thiocyanate interferes with iodine uptake by the thyroid.

B)

1) In this question please provide how much dose a doctor has ordered every 6 hours.

2) Adverse reactions to be observed by nurse

Following adverse reactions should be observed

symptoms of fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia or hypocalcemia): dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting.

3)

Furesmide is loop diuretic and hypokalemia is a common side effect to this.

Serum electrolytes (particularly potassium), CO2, creatinine and BUN should be determined.  Hypokalemia is an electrolyte characterized by low serum potassium concentrations (normal range: 3.5–5.0 mEq/L). Severe and life-threatening hypokalemia is defined when potassium levels are <2.5 mEq/L.

Serum and urine electrolyte determinations are particularly important when the patient is vomiting.

Reversible elevations of BUN may occur and are associated with dehydration, which should be avoided, particularly in patients with renal insufficiency.