Question

M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn that she is strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. The physician orders to start a PIV and give 80mg of furosemide IVP, place an indwelling foley catheter.

1. You administer furosemide 80mg IVP. What three parameters you would use to monitor the effectiveness of this medication?

Furosemide is prescribed to heart patients to treat fluid accumulation in the body. An expected outcome in this condition would be reduced edma in the legs of the patient. The urination frequency should be increased with larger amounts of fluid urinated. Urination frequency of the patient should increase, if the drug is working. Her shortness of breath decreasing or her SpO2 increasing due to a decreased amount of fluid in the lungs.

2. What teaching would you want to give this patient and what error in teaching occurred when MG was discharged 10 days ago?

The error that occurred was in teaching about the dietary restriction on salt and fluid. The patient reported gaining about 1 to 2 pounds daily after discharge.

Patient teaching should be on minimizing symptoms and preventing complications. Teach about taking medication according to the prescription and try to avoid skipping doses. Monitoring daily weight and if it increases more than 2 pounds report to the provider immediately. Assess and monitor for adverse side effects and when to report to a provider. Follow a strict fluid and sodium restriction diet. Since this was lapsed during teaching, I would ask her about foods that are good for her diet and foods that should be avoided.

3. What can you delegate to the NA?

Answer 1

1.The three parameters which can be used to assess the effectiveness of the medication are

• increased urine output
• Decrease in weight of the patient
• On lung auscultation no crackles should be heard

2.The error occurred was MG was not adviced how diet should be ,what level of sodium is recommended. The following teaching are necessary for effective diet

• Fresh fruits and vegetables are allowed
• Consume a low sodium diet
• Avoid processed and stored food,saturated fats ,refined sugar
• Nuts can be eaten but shoukd not be salted
• Avoid salt sprinklers

3.The NA can be delegated the following

• Monitoring vital signs (hypotension may occur due to excess fluid elimination )
• Monitor output of the patient
• The personal hygienic care like perinral care to prevent infection
• Position the patient ,provide back care