Question

1. HYPERVOLEMIA

A patient was admitted in the medical ward with chief complaints of shortness of breath. Further assessment reveals the following findings:

• BP –140/90 mm Hg
• HR –111 bpm
• RR –24 cpm
• +2 bipedal edema
• Bibasilar crackles upon auscultation

The doctor initially ordered furosemide 20 mg ampule TIV every 8 hours and the following laboratory tests: Complete Blood Count (CBC), Serum Sodium, Serum Potassium, Blood Urea Nitrogen, Serum Creatinine, Total Protein, and Chest X-ray.

1. Write down three (3) prioritynursing diagnoses for the patient and create a hypothetical FDAR.
2. What laboratory test may give the hint to the doctor about the oncotic pressure of the patient?
3. Create a drug study for FUROSEMIDE specifying the following:
   1. Drug classification
   2. Mechanism ofaction
   3. Indication (*for the case of the patient mentioned above)
   4. Contraindication
   5. Side effects
   6. Nursing Considerations

2. HYPOVOLEMIA

A teenage patient was rushed to the emergency department due to wrist laceration from a suicide attempt. The patient is lethargic and have the following findings upon assessment:

• BP –80/50 mm Hg
• HR –110 bpm
• RR –25 bpm

The doctor initially ordered fluid resuscitation with PNSS 1L, to fast-drip 200 cc then the remaining fluid to run for 6 hours. Stat blood typing was ordered, and 3 units of whole blood was ordered to be transfused immediately after proper cross-matching. The patient was hooked to oxygen 8 liters per minute via face mask.

1. What parameters will the nurse check while the patient is undergoing rapid fluid resuscitation?
2. For a patient who will undergo blood transfusion, enumerate the steps that the nurse should prudently undertake while performing the procedure.
3. List down three (3) priority nursing diagnoses for the patient and create a hypothetical FDAR.

3.THIRD SPACE EDEMA

A patient with portal hypertension secondary to chronic liver cirrhosis was admitted in the surgical ward. The patient presented with emaciated body build, distended abdomen with prominent veins, and jaundice. The doctor ordered paracentesis and the following laboratory tests prior the procedure: Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), Total Protein, Albumin-Globulin ratio, AST, ALT.

1. List down two (2) nursing diagnoses and create a hypothetical FDAR for the patient.
2. Why is there a need to check the PT and APTT levels of the patient prior paracentesis?
3. What is the rationale behind the order of checking the Total Protein, Albumin-Globulin ratio?
4. Enumerate the following regarding the nursing role in assisting with paracentesis:

• Position of choice
• Site of insertion
• At least three (3) nursing considerations.

Answer 1

Answer 1.Hypervolemia or fluid volume excess is a condition occurs due to an isotonic expansion of the Extra cellular flui due to an increase in total body sodium content and an increase in total body water.This fluid overload usually occurs from compromised regulatory mechanisms for sodium and water as seen commonly in heart failure,kidney failure and liver failure o

Based on the assessment data 3 priority nursing diagnosis

1 Excess fluid over load

Nursing interventions

Instruct patient care giver and family members regarding fluid restrictions.Limit sodium intake.Restriction of sodium aids in decreasing fluid retention.

Monitor fluid intake

2 Edematous extremities

Intervention

Elevate edematous extremities,and handle with care.Elevationincreases venous return to the heart and I turn decreases edema

Maintain intake and output,Daily weight,Monitor and note BP and HR

Assess urine output in response to diuretic therapy

Limit sodium intake

3)Discomfort due to shortness of breath

Intervention

place the patient in a semi Fowler’s position raising the head of the bed provides comfort in breathing

2) Albumin test will give the hint to the doctor about the oncotic pressure of the patient

3) Drug study

Furosemide is a loop diuretic that prevent your body from absorbing too much salt

Mechanism of action

It inhibits the luminal Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle,by binding to the chlorine transport channel,thus causing sodium,chlorine and pottasium loss in urine

Contra indicated in Diabetes,gout,low amount of calcium in the blood,low amount of sodium,potassium and chlorine in the blood

Side effects: Increased ruination,thirst,muscle cramps dizziness weakness spinning sensation and diarrhea.

Nursing considerations

Assess fluid status,Monitor daily weight intake and output,amount of locations of edema,lung sounds,skin turbot and mucous membranes

Answer 2

Hypovolemia due to blood loss parameters to be checked

• Monitoring of vital signs/haemodynamic parameters such as central venous and arterial pressures
• Heart rate
• Mean arterial pressure
• Signs of circulations such as skin color/perfusion and tissue perfusion

1)Decreased cardiac output

2) Deficient fluid volume

3) Ineffective tissue perfusion

Interventions:

• Monitor hemodynamics Mean arterial pressure,CVP,SVR
• Rapid IV bolts fluids. Fluids should be given as soon as fast as possible to to to restore circulating the volume.
• Administer blood products