Question

Renal Case Study: 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 is experiencing significant dyspnea upon exertion. You are caring for him and are responsible for 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 Cannula Temp: 98.9 degrees F Medications: Metoprolol 25mg PO BID Lasix 40mg PO BID Lisinopril 20mg PO BID Prednisone 10mg PO Daily 1. What should your detailed nursing assessment consist of at this time? 2. What laboratory results will you look for? Why? 3. How will you know that the Lasix has been effective? 4. What medication(s) may be problematic concerning the patient's diabetes? S The patient's creatinine is 2.5, what medications may need to be held? Why? 6, What diet should the patient be on? 7. What will you report to the physician? Why?

Answer 1

1. The detailed nursing assessment includes:

In the assessment phase the nurse collects, subjective data from patient and objective data about the actual and potential clinical problems for the patient by disease.

Clinical nursing care for clients with heart failure are:

a. Monitoring of vital signs as patient with heart failure will have sub - normal changes in vital signs.

The pulse, blood pressure, respiration, saturation and body temperature are to be monitored and immediate nursing interventions are to be taken.

b. Life- style modification for the patient

c. Diet modification for patient

d. Administration of medication and oxygen therapy.

2. The laboratory blood tests like complete blood count ( CBC), urea and electrolytes changes occur in heart failure.

The red blood cell count is verified to check oxygen carrying capacity and hypoxia. WBC count to rule out immunity. Urea is monitored to rule out possible retention of urea and metabolic acidosis. Electrolytes like sodium and potassium imbalances which may lead to heart arrhythmia and heart arrest.

3. Lasix , a diuretic often called water pill, makes to urinate more frequently and keep fluid collecting from body. It also decrease fluid in lungs so breathing difficulty can be limited.

4. Concerning the patients diabetes with heart failure NSAIDS i.e. prednisolone is problematic.

5. The patients increased creatinine levels is a sign of worsening kidney function. The angiotensin converting enzyme ( ACE) inhibitors I.e. Lisinopril is to be with hold.

6. Diet plays an important role in maintenance of health of a patient with heart failure. The diet golden formula is low salt and fat free diet. Low salt or salt free diet minimises the risk of fluid retention and fat free diet minimises the risk of ischemic heart disease.

7. Changes in vital signs i.e high temperature, low saturation < 90%, high pulse, increased blood pressure , dyspnea , decreased respiration rate, fluid buildup in abdomen and legs, excess urine output, abnormal laboratory findings.etc. need to be reported to physician as they are the emergency signs of sudden heart failure.