Question

CASE SCENARIO:

An 80 year-old woman fell in her home. She is evaluated in the emergency room and is found to have a hip fracture. She was recently started with hydrocholorothiazide to treat her hypertension. She has been on an SSRI for depression following the loss of her husband and is taking NSAIDs for pain associated with osteoarthritis. Her vitals are stable. She is lethargic and disoriented but otherwise appears well. Laboratory works reveals Na – 105 mEq/L, K – 3.2 mEq/L, BUN – 32 mg/dL, Creatinine – 1.0 mg/dL.

1. Would this case suggest hypovolemia? If it is a case of hypovolemia, what was the cause and what type is it?
2. How would you manage this patient?
3. What are your nursing priorities in providing care to this patient?
4. Provide the title of the case scenario based on the cause of the problem.

Answer 1

1, Patient taking hydrochlorothiazide causes severe dehydration that causes low blood pressure and severe electrolyte imbalance. while taking this medication patient need to take frequent medical test and blood pressure checkup.it causes hypokalemia and hyponatremia for the patient. patient taking NSAID drugs that alter the renal function by inhibiting renal hemodynamic action and GFR function in the kidney. patient sodium and potassium level are low, BUN level increased, and creatinine within the normal range. there are adverse outcomes from the SSRI with NSAIDs, that cause a high risk of upper GI bleeding. precaution must be needed with taking this medication altogether. patient hypovolemic hyponatremia causes water retention that increases the plasma dilution and hyponatremia.it is absolute hypovolemia due to inadequate organ perfusion due to loss of intravascular volume.
2, check the patient vitals frequently. check the patient's electrolyte on a regular basis. stabilize the patient's hip and avoid moving the patient. prescribe analgesics for the patient as per the doctor advice. replace the patient fluid and electrolyte volume, vasopressor can be administered if the patient is hypotensive.
3, Patient pain should be stabilized and most priority for the patient to replace the fluid and electrolyte first and the patient should be prepared for surgery. provide support to the patient and eliminate the patient depression and anxiety. check the patient neurological status frequently.
4, Title: hydrochlorothiazide drug interactions