Question

Case scenario:

Ms. Castro, a patient on the medical-surgical unit, was admitted 2 days before with a diagnosis of exacerbation of heart failure. This morning her BP is 175/80 mm Hg. She denies chest pain, but state that she has been experiencing shortness of breath. She tells the nurse she uses three pillows to be able to breathe at night while sleeping. Her baseline weight at admission was 170 lb., but this morning’s scale indicates a 4-lb weight gain, and +3 pitting edema to the lower extremities is evident. The nurse telephones the doctor and receives an order for furosemide 40 mg by mouth twice daily and metoprolol 25 mg PO daily to start immediately.

1. Which lab should the nurse review prior to administering furosemide and metoprolol?

2. When she attempts to administer the furosemide, the patient states. “I don’t want the water pill”. What is the nurse’s next action?

3. What important information should the nurse document into MS. Castro’s medical record 30 minutes after administering the medication?

Answer 1

1. Which lab should the nurse review prior to administering furosemide and metoprolol?

ANSWER:

Monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before administering furosemide.

BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels should be monitored before administering metoprolol.

2. When she attempts to administer the furosemide, the patient states. “I don’t want the water pill”. What is the nurse’s next action?

ANSWER: Talk to the patient, explain the purpose of taking that medicine, how it will help to recover the illness in her body and explain the need to take such medicine. Also add what can be the possible consequence if not taking medicine in time. Tell the patient that these drugs help your kidneys get rid of extra water and salt from your body through your pee.

Inform the physician if the patient still refuse to take the medicine

3. What important information should the nurse document into MS. Castro’s medical record 30 minutes after administering the medication?

ANSWER:

Document the name of medicine administered to the patient along with dose, route, time and sign your name with date and time in patient’s file.

Write other details which the patient inform or refuse about the medication.

After administering check the condition of the patient.

Any decrease in oedema, abdominal girth and weight.

Check increase in urinary output and increased in BP.