Question

George Brown, 72 years of age, is a male patient who is admitted with the diagnosis of acute pulmonary edema secondary to acute left ventricular heart failure. The patient has a history of coronary artery disease that has been treated medically. The patient is anxious, pale, cold, clammy, and dyspneic. The vital signs are: blood pressure 88/50 mm Hg, heart rate 110 bpm, respiratory rate 32 breaths/min, and temperature 97°F. There are bubbling crackles and wheezing throughout the lung fields and the patient is raising frothy blood-tinged clear sputum. The patient’s admission weight is 100 kg.

a. What first actions should the nurse take and what are the rationales for these actions?

The physician ordered furosemide (Lasix) 40 mg IVP STAT.

b. What are the actions of furosemide that will help the patient?

c. What nursing actions should be implemented when administering a diuretic?

Answer 1

Pulmonary edema

The accumulation of fluid in the tissues of the lungs is called Pulmonary edema.

Left ventricular heart failure

Left ventricular failure is a condition characterised by inefficient pumping of left ventricle, causes the back flow of blood to lungs , resulting in breathing difficulty and pulmonary edema.

Nursing Actions

Acute pulmonary edema followed with acute left ventricular heart failure is a medical emergency. Emergency nursing actions includes:

* Oxygen supplementation with face mask: To improve oxygenation to the tissues

* provide a sitting position or semi sitting position for the patient or elevate the head end of the bed: to ease breathing. this position gives an increase in chest expansion

* Monitor vital signs

* Obtain ECG( echocardiogram)

* Monitor pulse oxymetry

* Start Intravenous administration as per Doctor's order

* Keep ready emergency trolley

* check for any complications

Furosemide

A diuretic used in the treatment of heart failure and edema. Diuretics are the drugs that used to increase the amount or frequency of urination.

Action: Furosemide is a loop diuretic. It inhibits the reabsorption of water,sodium, chloride and potassium in the tubules of nephrons. Thereby increasing urine output and reduce water retention in the body.

Nursing Actions when administring a diuretic

* Monitor vital signs of the patient

* Monitor fluid overload , maintain intake and output cart

* Monitor serum sodium , potassium values to detect any electrolyte imbalance

* Check the patient's weight daily( weight gain indicates water retention)

* Check for any disturbance in consciousness or dizziness

* Check for any disturbances in vision or hearing( it may be an indication of toxicity of diuretics

* Check for any allergic condition