Question

Patty Mills is a 74-year-old female with a past medical history of coronary artery disease with stent placement, hypertension, and diabetes. Her son brought her to the Emergency Department because she has become increasingly weak and confused and was found by a neighbor wandering her neighborhood unable to locate her home. Patty’s son tells the nurse that his mother takes a "water pill" for her blood pressure 2 or 3 times a day. The label on the medication bottle that she brought to the hospital states, “Furosemide 40mg BID". Patty is admitted with fluid volume deficit.

1. What health challenges does your patient face? (Please give more than one). - (This is not a list of their symptoms, but critical elements that will cause/place the pt. a risk for a global problem, ex; pt. is immobile, NPO, and incontinent – one of the global issue here is r/t skin )
2. What on-going assessments and monitoring does your patient require related to their health challenges? (ie both inpatient and outpatient)

Answer 1

When the patient has taken furosemide 40mg two or three times a day which is a diuretic which will go into fluid volume deficit due to excessive urination and can lead to hypovolemic shock .

Health challenges in patient's with fluid volume deficit are

Dehydration:patient will have sunken eyes,dry mouth, flaky skin,dry skin,patient will have sodium imbalance due to rapid sodium loss patient may go into stupor,coma lead to contractures and can be fatal .

Electrolyte imbalance:The another big challenge in fluid volume deficit is electrolyte imbalance both sodium and potassium will be low and may cause rapid cardiac dysfunction like arrhythmia,sodium imbalance may cause stupor,confusion,lethargy,weakness ,coma .it can also lead to kidney disease .and since this patient is diabetes it can lead to diabetic ketoacidosis.

Pressure ulcer:Another challenge of fluid volume deficit is dry and flacky skin along with malnutrition which can lead to impaired skin integrity and cause bed sores .

Mouth ulcers:This another challenge of fluid volume deficit which can lead to mouth ulcer due to dehydration.

Self care deficit:patient with fluid volume deficit will not be healthy enough to perform activities of daily living .

Ongoing Assessment.

Skin Assessment:whether the patient is in the hospital or at home skin Assessment especially bony prominence should be assessed for any nonblanchable redness which is the first degree of pressure ulcer .in hospital the assessment should be done every shift and at home it should be done at least once a day . Prophylaxis to prevent bed sore should be followed like air mattress,patches.

Oral Assessment:Patients on furosemide and other diuretic medication and if the patient is elderly should be assessed for mouth ulcers .

Neurological Assessment:Patients prescribed in diuretics should be assessed everyday for mentation like consiusness, orientation and ability to perform self care activities .

Assessment for dehydration:Advice the relatives to assess skin ,sunken eyes,dry mouth,weakness , lethargy, confusion at home for elderly patients in diuretic therapy.

Electrolyte Assessment: elderly patients with diabetes and on diuretics regular blood glucose , electrolyte should be measured to maintain the normal levels and to prevent electrolyte imbalance complications.

Nutritional Assessment:patients on diuretics should be assessed for fluid intake like oral fluids.