Question

Renal Case Study: John Smith, 68 year-old male, is diagnosed with heart failure. He is also an asti usually on 2 liters of oxygen, but is now requiring 6 liters of oxygen by experiencing significant dyspnea upon exertion. You are caring for him and interpreting his medication orders and subsequent nursing implications. he and medications: He is also an asthmatic and diabetic. He is of oxygen by nasal cannula. John is for him and are responsible for implications. Here are John's current vitals 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? 5 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

Heart failure is also known as Congestive heart failure. It is the inability of the heart to pump enough oxygen and nutrients to the tissues characterized by signs and symptoms of fluid overload or of not adequate tissue perfusion.

1. The primary assessment that a nurse should assess here in case of heart failure is clearing out fluid overload. Because of fluid overload, the patient is having difficulty in breathing (dyspnea) which is the reason for the increased supplement of oxygen level.

2. A laboratory test that can be done at this time is BNP. It is done to screen out heart failure and to look for possible causes or triggers of heart failure. If there is a high levels of BNP, it indicates there is a link with heart failure. Other conditions like diabetes, reduced kidney function can either cause or complicate heart failure.

The other blood tests like renal function test and electrolytes can be done. Because of fluid overload there is a chance of less renal functioning and also electrolytes imbalances. Moreover, he is a diabetes patient. So, all these conditions may leads to alteration in renal functions.

3. Lasix is an anti-diuretic drug used to treat fluid retention and thereby it reduces the blood pressure in patients. It acts on the kidneys to increase the flow of urine. So, fluid overload or edema can be reduced and so the patient dyspnea.

4. Metoprolol and lisinopril should be avoided in patient with diabetes. Metoprolol is a beta blocker should be avoided in patient with diabetes to avoid the symptoms of hypoglycemia. Also, in patient with diabetes, renal blood pressure becomes higher. In such cases giving lisinopril interferes the process of vascular contraction, which reduces blood pressure.

5. Lasix should be withheld if a patient have high creatinine. Giving this medicine highly leads to the deterioration of further renal function because it is a potent diuretic which leads to further water and electrolyte depletion.

6. The patient with renal failure should limit their protein, sodium, phosphorus and potassium rich diet. Moreover, water intake should also be limited.

7. The blood report should be informed to the doctor. Because the patient is having diabetes, dyspnea and low renal function. Moreover, the patient is on Metoprolol, lasix and lisinopril. The blood test report should be informed to the physician to halt all these medications and to seek other ways to improve cardiac and renal function.