Your next patient is Mr. Johnson, who also has congestive heart failure. He is taking furosemide...

Your next patient is Mr. Johnson, who also has congestive heart failure. He is taking furosemide (Lasix) as part of his drug regimen. He says, “These are my water pills, the doctor tells me. They make me go and go!” Furosemide acts in the ascending limb of the Loop of Henle to block the NKCC transporter (ie, prevent it from transporting Na+, K+, and 2Cl- from the tubular fluid into the tubular epithelial cells). Why does the furosemide (Lasix®) make Mr. Johnson urinate so much?

Expert Solution

Furosemide (Frusemide)
Because it is a HIGH CEILING (LOOP) DIURETIC. Diuretics (natriuretics) are drugs which cause a net loss of Na+ and water in urine.

Prototype drug The development of this rapidly acting highly efficacious oral diuretic was a breakthrough. Its maximal natriuretic effect is much greater than that of other classes. The diuretic response goes on increasing with increasing dose: upto 10 L of urine may be produced in a day. It is active even in patients with relatively severe renal failure. The onset of action is prompt (i.v. 2–5 min., i.m. 10–20 min., oral 20–40 min.) and duration short (3–6 hours).
The major site of action is the thick AscLH (therefore called loop diuretics) where furosemide inhibits Na+- K+-2Cl ̄ cotransport . A minor component of action on PT has also been indicated. It is secreted in PT by organic anion transport and reaches AscLH where it acts from luminal side of the membrane. The cortico- medullary osmotic gradient is abolished and positive as well as negative free water clearance is blocked. K+ excretion is increased mainly due to high Na+ load reaching DT. However, at equinatri- uretic doses, K+ loss is less than that with thiazides.
Furosemide has weak CAse inhibitory action;
increases HCO ̄ excretion as well; urinary pH 3
may rise but the predominant urinary anion is Cl ̄. Therefore, acidosis does not develop. The diuretic action is independent of acid-base balance of the body and it causes little distortion of the same; mild alkalosis occurs at high doses.

Sydney Mullin answered 1 year ago

Case Study 2 Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who...

Case Study 2 Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical...

what are Primary, Secondary, Tertiary prevention needs for a patient with Congestive Heart Failure related to...

what are Primary, Secondary, Tertiary prevention needs for a patient with Congestive Heart Failure related to inadequate support systems? what are S.M.A.R.T Objectives for a patient with inadequate support systems related to CHF?

. The patient was a 77-year-old female admitted with Congestive Heart Failure, and past medical history...

. The patient was a 77-year-old female admitted with Congestive Heart Failure, and past medical history of an Acute MI, four to six months before admission date. She had been taking Lasix 40mg PO BID and Cardizem 30 mg TID. In a report, I heard that her last O2 saturation was 77% on 3 liters via nasal cannula. Vital signs- afebrile, HR 108, RR 22, BP 148/88. She had an IV of D5W at KVO, the EKG was done, and...

George, 88 years old, is suffering from congestive heart failure. He was admitted to the hospital...

George, 88 years old, is suffering from congestive heart failure. He was admitted to the hospital with a diagnosis of extracellular fluid volume excess. He was frightened and slightly confused and dyspneic on exertion. what symptoms does the nurse expected to find when performing the assessment on this patient? what manifestation of extracellular fluid volume excess does the nurse anticipate finding? When developing a plan of care for the patient, which interventions should the nurse include?

For a congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) patient, select one application...

For a congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) patient, select one application or a technology that could effectively increase patient engagement and patient outcomes for your future practice area or work focus. What elements of this application or technology are the most valuable to you? How could you improve this technology?

Patient Teaching to a 79 years old patient who has heart failure and newly diagnosed 1....

Patient Teaching to a 79 years old patient who has heart failure and newly diagnosed 1. Create a patient scenario (3-4 sentence that describes your client's situation that necessitates teaching) 2. Assessment data indicating a learning need (include pertinent positive/negative data) 3. Nursing diagnosis that indicates the need for patient teaching (NANDA stem, r/t and AEB) 4. expected outcome (use action very and time frame in terms of the client) 5. methodology/tools (what equipment, instructions aids, method of communication) 6....

Case Example: A 68-year-old man with diabetes and chronic congestive heart failure who is prescribed digitalis...

Case Example: A 68-year-old man with diabetes and chronic congestive heart failure who is prescribed digitalis and insulin presents to the emergency department with abdominal pain and cramping. Upon exam, the he is noted to have hyperactive reflexes. An ECG shows a prolonged PR interval, widened QRS and depressed ST segment. 1.What electrolyte imbalance is this patient most likely suffering from?

John Smith, 68 year-old male, is diagnosed with heart failure. He is also an asthmatic and...

John Smith, 68 year-old male, is diagnosed with heart failure. He is also an asthmatic and diabetic. He is usually on 2 liters of oxygen, but is now requiring 6 liters of oxygen by nasal cannula. John experiencing significant dysp upon exertion. You are caring for him and are responsible for nea interpreting his medication orders and subsequent nursing implications. Here are John's current vitals and medications: Vitals: HR: 58 BP: 168/90 RR: 24 Spo2: 90%, 6 Liters per Nasal...

The psychiatric nurse is initiating an interview with Mr. Johnson. He is a 33-year-old male patient...

The psychiatric nurse is initiating an interview with Mr. Johnson. He is a 33-year-old male patient admitted to the Behavioral Center with a diagnosis of schizophrenia. The nurse begins the interaction by saying, “What shall we talk about today?” (Learning Objective: 2) a. Explain why this is an appropriate opening statement to initialize a clinical interview session. b. Why should the nurse use simple, concrete, and direct messages with the patient?

Greg Wilson, a 65-year-old man, is diagnosed with pneumonia. He has a history of congestive heart...

Greg Wilson, a 65-year-old man, is diagnosed with pneumonia. He has a history of congestive heart failure. His physician has ordered an antibiotic for the pneumonia and he takes digoxin every day. As the health care provider, which question would you ask first before administering his antibiotic? Why is the first dose of the antibiotic twice as much as the maintenance dose? Which variables may slow his metabolism and excretion?

Question