1. List reference values for serum potassium, serum sodium, and serum chloride. Are ST`s electrolyte levels within normal range? Explain your answer?
2. Match ST`s physical findings with the corresponding electrolyte imbalance.
3. What are the reasons for the electrolyte imbalance?
4. ST said she was not taking KCL because the drug makes her sick. What information can you give her concerning the administration of potassium?
5. What is the effect of furosemide on digoxin when there is a potassium deficit? Explain your answer.
6. Why should the nurse assess ST for digitalis toxicity? List the signs and symptoms of digitalis toxicity. ST was referred to the health care provider because of her serum potassium deficit and its effect on digoxin. A repeat serum potassium determination was taken and the result was administered over 4 hours.
7. How many milliequivalents of KCL. Does this amount constitute an acceptable dosage?
8. Why is important that the nurse monitor the rate of intravenous fluids containing potassium, the hourly urine output, and vital signs?
9. Because of the low serum potassium level, what other electrolyte value should be checked? Explain your answer After ST`s serum electrolyte returned to normal, the health care provider instructed her to continue taking the prescribed kcl dosage daily with her other medications.
10. ST asks why has to continue taking these drugs .What is the nurse`s best response?
11. The nurse instructs ST to eat foods rich in potassium?
1. List reference values for serum potassium, serum sodium, and serum chloride. Are ST`s electrolyte levels within normal range? Explain your answer?
Reference values for serum potassium is 3.5-5.0 mEq/L, Serum sodium is 135-145 mEq/L, Serum chloride 95-105 mEq/L. In the case of ST, serum potassium was not in the normal range, however, serum sodium and chloride was under the normal range
2. Match ST`s physical findings with the corresponding electrolyte imbalance.
The physical findings of ST was potassium 2.9mEq/L, sodium 137 mEq/L, and chloride 96 mEq/L. Here serum potassium had lower levels than the expected normal level of 3.5-5.0 mEq/L. Serum chloride and serum sodium are in the normal reference range.
3. What are the reasons for the electrolyte imbalance?
electrolyte imbalance characteristics can be created by an inadequacy or an excess of minerals in the body
4. ST said she was not taking KCL because the drug makes her sick. What information can you give her concerning the administration of potassium?
By the administration of potassium through Kcl, basic reactions incorporate fever, disease, redness, torment, or swelling at the infusion sit
5. What is the effect of furosemide on digoxin when there is a potassium deficit? Explain your answer.
Furosemide is a potassium-squandering circle diuretic. This implies that it causes abundance loss of potassium from your body. Low potassium levels can be risky on the off chance that you are likewise taking digoxin. You are more prone to create digoxin poisonous quality on the off chance that you have low potassium levels. High potassium levels help keep digoxin from collecting in your body. At the point when bringing digoxin with furosemide, build your admission of potassium-rich sustenances.
6. Why should the nurse assess ST for digitalis toxicity? List the signs and symptoms of digitalis toxicity. ST was referred to the health care provider because of her serum potassium deficit and its effect on digoxin. A repeat serum potassium determination was taken and the result was administered over 4 hours.
The primary side effects of this condition influence the stomach, breathing, and vision. Since the condition is a type of harming, you will probably lose your voracity and experience sickness, regurgitating, and/or looseness of the bowels. Your heart may additionally pulsate speedier or slower than common, or you may have an unpredictable pulse.
7. How many milliequivalents of KCL. Does this amount constitute an acceptable dosage?
1 mEq KCl = 1/1000 x 74.5 g = 0.0745 g = 74.5 mg
8. Why is important that the nurse monitor the rate of intravenous fluids containing potassium, the hourly urine output, and vital signs?
Patients ought to have an IV fluid administration arrangement, which ought to incorporate points of interest of the fluid and electrolyte remedy through the following 24 hours and the appraisal and observing arrangement. At first, the IV fluid administration arrangement ought to be inspected by a specialist day by day. IV fluid administration plans for patients on more term IV fluid treatment whose condition is stable may be checked on less much of the time. When recommending IV fluid and electrolytes, consider all different wellsprings of fluid and electrolyte admission, including any oral or enteral admission, and admission from medications, IV sustenance, blood and blood items. Patients have an important commitment to make to their fluid parity. On the off chance that a patient needs IV fluids, clarify the choice, and examine the signs and manifestations they have to pay special mind to if their fluid adjust needs modifying.
9. Because of the low serum potassium level, what other electrolyte value should be checked? Explain your answer After ST`s serum electrolyte returned to normal, the health care provider instructed her to continue taking the prescribed kcl dosage daily with her other medications.
Serum or plasma tests for potassium levels are done on a frequent basis in many patients when they are examined for any kind of genuine ailment. Likewise, on the grounds that potassium is so essential to heart capacity, it is generally requested (alongside different electrolytes) amid all complete routine assessments, particularly in the individuals who take diuretics or circulatory strain or heart pharmaceuticals. Potassium testing is requested when a specialist is diagnosing and assessing (hypertension) and kidney sickness and when observing a patient accepting dialysis, diuretic treatment, or intravenous treatment.
10. ST asks why has to continue taking these drugs .What is the nurse`s best response?
In the event that the hypokalemia is serious, or the misfortunes of potassium are anticipated to be progressing, potassium substitution or supplementation may be needed
11. The nurse instructs ST to eat foods rich in potassium?
Potassium is a mineral found in shifting sums in all foods. Vegetables, particularly green leafy vegetables, are by and large our wealthiest wellsprings of potassium. Most of us have the capacity to acquire enough potassium from foods to meet our most fundamental needs. Yet since simply meeting a negligible admission need is not a formula for wellbeing, numerous individuals regularly neglect to get ideal measures of this supplement, and pay a wellbeing expense for it.
1. How doeshydrochlorothiazide differfrom furosemide (Lasix)? What are their similarities and differences?
Viability of furosemide, 40 mg twice every day, was contrasted and hydrochlorothiazide, 50 mg twice day by day, in hypertensive patients. Both hydrochlorothiazide and furosemide essentially decreased pulse (BP) amid three months of treatment. Nonetheless, the fall in BP was reliably more prominent with hydrochlorothiazide than with furosemide, in spite of the fact that the distinction was noteworthy just regarding systolic BP. The to a degree more prominent antihypertensive viability of hydrochlorothiazide may be identified with its more drawn out activity allowing a more constant diuretic impact and, henceforth, upkeep of decreased extracellular liquid volume all through the 24-hour period.
2. Why is it necessary for JQ to eat foods rich in potassium when taking hydrochlorothiazide? Explain your answer.
Hydrochlorothiazide is a diuretic regularly used to treat hypertension furthermore edema, or liquid maintenance, and congestive heart disappointment. It is a thiazide diuretic, the most regularly utilized kind of diuretic and one of the slightest costly. One symptom of thiazide diuretics is potassium misfortune. Potassium supplements may be expected to keep potassium levels inside ordinary points of confinement.
3. What are the nursing interventions that should be considered while JQ takes hydrochlorothiazide? After one month on hydrochlorothiazide therapy, JQ becomes weak and complains of nausea and vomiting. His muscles are “soft.” Serum potassium level is 3.3 mEq/L.JQ`s diuretic is changed to triamterene/hydrochlorothiazide (Dyazide). Again, he is advised to eat foods rich in potassium.
Hydrochlorothiazide is utilized alone or as a part of blend with different drugs to treat hypertension. Hydrochlorothiazide is utilized to treat edema (liquid maintenance; abundance liquid held in body tissues) created by different restorative issues, including heart, kidney, and liver infection and to treat edema brought on by utilizing certain prescriptions including estrogen and corticosteroids. Hydrochlorothiazide is in a class of drugs called diuretics (‘water pills’). It lives up to expectations by bringing on the kidneys to dispose of unneeded water and salt from the body into the pee.
Hypertension is a typical condition and when not treated, can bring about harm to the cerebrum, heart, veins, kidneys and different parts of the body. Harm to these organs may bring about coronary illness, a heart assault, heart disappointment, stroke, kidney disappointment, loss of vision, and different issues. Notwithstanding taking pharmaceutical, rolling out way of life improvements will likewise help to control your circulatory strain. These progressions incorporate eating an eating regimen that is low in fat and salt, keeping up a solid weight, practicing no less than 30 minutes most days, not smoking, and utilizing liquor as a part of balance.
4. Explain the rationale for changing JQ`s diuretic.
Diuretics frequently are consolidated with other hypertension pharmaceuticals. A portion of the brand names recorded here are a mix of a diuretic and another drug. Utilizing both a diuretic and another pharmaceutical frequently functions admirably, on the grounds that diuretics can improve the impact of alternate meds and in some cases keep the liquid maintenance that can happen.
5. Should JQ receive a potassium supplement? Explain your answer.
An eating routine that incorporates common wellsprings of potassium is vital in controlling circulatory strain on the grounds that potassium decreases the impacts of sodium. The suggested every day admission of potassium for a normal grown-up is around 4,700 milligrams every day. Yet potassium ought to be considered as just piece of your aggregate dietary example. Elements, for example, salt admission, sum and sort of dietary fat, cholesterol, protein and fiber, and also minerals, for example, calcium and magnesium may influence pulse. Specialists characteristic changes in circulatory strain to specific examples of nourishment utilization
6. What nursing interventions should the nurse follow for JQ?
Keep up/upgrade cardiovascular working, Counteract complications, Give data about ailment process/visualization and treatment regimen, Bolster dynamic patient control of condition.
7. What care plan should the nurse develop for JQ in relation to patient teaching?
A nurse can ask the patient to take part in exercises that decrease BP/cardiovascular workload. Keep up BP inside independently worthy extent.Exhibit stable cardiovascular musicality and rate inside quiet’s ordinary extent. Partake in exercises that will avert (stress administration, adjusted exercises and rest arrangement).
8. What medical follow-up care is needed for JQ?
Regular blood pressure check ups are essential to screen readings and choose a treatment arrangement. Based on the age of the patient and the common movement of solidifying of the courses, systolic pulse may hoist after some time. A treatment that once functioned admirably might no more act too and your medicine treatment may need to be changed. Conducting regular physical exams and screening blood tests may be recommended to help screen the achievement of pulse administration.
1.Why was hydrochlorothiazide prescribed for GG? Explain the effects of hydrochlorothiazide on blood pressure.
This prescription is utilized to treat hypertension. Bringing down hypertension helps anticipate strokes, heart attacks, and kidney issues. Hydrochlorothiazide is a “water pill” (diuretic) that makes you make more pee. This helps your body dispose of additional salt and water. This drug additionally lessens additional liquid in the body (edema) created by conditions, for example, heart disappointment, liver ailment, or kidney infection. This can diminish manifestations, for example, shortness of breath or swelling in your lower legs or feet.
2. Abnormal electrolytes and other laboratory test results may occur when taking hydrochlorothiazide.
Would the following serum electrolytes and other laboratory values be expected to increase or decrease?
A, Sodium
3. Why should GG`s blood glucose level be monitored while she is taking hydrochlorothiazide?
Consolidating certain medications with diabetes can bring symptoms that are adverse, so you must know how hydrochlorothiazide influences your glucose.
4. What effect may result when GG takes digoxin and hydrochlorothiazide together/ Explain your answer.
Digoxin (Lanoxin) – Low blood levels of magnesium can expand negative impacts from digoxin, including heart palpitations and queasiness. Moreover, digoxin can bring about more magnesium to be lost in the pee. A specialist will screen magnesium levels in individuals taking digoxin to see whether they require a magnesium supplement. Diuretics – Two sorts of diuretics known as circle, (for example, furosemide or Lasix) and thiazide (counting hydrochlorothiazide) diuretics can lower magnesium levels.
5. Atenolol is what type of antihypertensive? Would atenolol be effective in lowering GG`s blood pressure if given as the only antihypertensive drug? Explain your answer.
antihypertensive treatment with atenolol gives weaker defensive activity against cardiovascular complexities (e.g. myocardial dead tissue and stroke) contrasted with other antihypertensive medications. At times, diuretics are prevalent
6. How effective is the combination of hydrochlorothiazide and atenolol for controlling GG`s blood pressure? Explain your answer.
Patients with uncomplicated hypertension were randomized to get either hydrochlorothiazide (HCTZ) or atenolol monotherapy, took after by expansion of the option drug. Pulse (BP) reactions were assessed by race and request of medication start.
7. When using a combination drug therapy to correct hypertension, would the dosage for each drug be the same? Explain your answer.
The dosage of these two drug will be different.
8. When abruptly discontinuing beta blockers for hypertension without the patient taking another antihypertensive, what might occur? Explain how adverse effects can be avoided.
GG`s blood glucose is 229. Her drugs for controlling hypertension are changed to prazosin 10 mg tid. Her cholesterol and LDL are elevated. Her serum potassium level is 3.2 mEq/L
Ceasing a beta-blocker abruptly could trigger palpitations, an attack of chest pain(angina) or may increase the hypertension.
9. Why were GG`s hydrochlorothiazide and atenolol discontinued? Explain your answer.
While hydrochlorothiazide and atenolol discontinued all of a sudden, it will lead to adverse effects.
10. What type of antihypertensive is prazosin? Explain the physiologic action of prazosin for lowering the blood pressure.
This is a is a sympatholytic medication used to treat hypertension and uneasiness, PTSD, and frenzy issue. It is an alpha-adrenergic blocker that is particular for the alpha-1 receptors.
11. Does prazosin have an effect on the blood glucose level? What effect could prazosin have on GG1s abnormal lipid levels? Explain your answer. GG`s ankles have becomes edematous. Hydrochlorothiazide is prescribed
prazosin is an alpha-blocker and thiazide diuretic blend. It meets expectations by extending veins and helping the kidneys wipe out additional liquid from your body, which helps lower pulse.
12. Why was hydrochlorothiazide added again to the drug regimen?
Hydrochlorothiazide is a thiazide diuretic (water pill) that aides keep your body from retaining an excessive amount of salt, which can bring about liquid maintenance.
13. Is the daily prazosin does within the safe therapeutic prescribed range for GG? Explain your answer.( You may refer to prototype Drug Chart 44-2)
Measurement may be gradually expanded to an aggregate day by day measurements of 20 mg given in isolated dosages. Measurements higher than 20 mg as a rule don’t build adequacy, however a couple of patients may advantage from further increments up to a day by day measurement of 40 mg given in isolated dosages
14. List the groups of antihypertensive drugs that can cause sodium and water retention.
Angiotensin-changing over enzyme inhibitors (ACE inhibitors) act by hindering the generation of angiotensin II, a substance that affects both choking of veins and maintenance of sodium, which prompts water maintenance and expanded blood volume.
1. Was TM1s heparin order within the safe daily dosage range?
Consistent IV Infusion: 5000 units IV one time as a bolus dosage took after by 1300 units/hour by ceaseless IV mixture. Then again, a bolus dosage of 80 units/kg IV one time took after by 18 units/kg/hour by nonstop IV imbuement may be utilized.
2. What are the various methods for administering heparin?
All randomized controlled trials (individual and group) contrasting the adequacy and wellbeing of distinctive strategies for overseeing subcutaneous heparin (UFH or LMWH)
3. Why was an apt test ordered? How would you determine whether TM is within the desired range? Explain your answer.
After 5 days of heparin therapy, TM was prescribed warfarin( Coumadin) 5mg po daily. An INR test was ordered.
The actuated partial thromboplastin time (APTT) test mirrors the exercises of the vast majority of the coagulation variables, including component XII and other “contact components” (prekallikrein [PK] and high-sub-atomic weight kininogen [HMWK]) and elements XI, IX, and VIII in the inborn procoagulant pathway, and also coagulation considers the regular procoagulant pathway that incorporate elements X, V, II and fibrinogen (element I). The APTT additionally relies on upon phospholipid (a halfway thromboplastin) and ionic calcium, and an activator of the contact variables (eg, silica), yet reflects neither the extraneous procoagulant pathway that incorporates element VII and tissue variable, nor the action of component XIII (fibrin settling component).
4. What is the pharmacologic action of warfarin? Is the warfarin does with in the safe daily dosage? Explain Your answer.
Warfarin is an anticoagulant ordinarily utilized as a part of the counteractive action of thrombosis and thromboembolism, the development of blood clusters in the veins and their relocation somewhere else in the body,
5. What are the half-life and proteon-binding for warfarin? If a patient takes a drug that is highly protein-bound, would there be a drug interaction? Explain your answer.
The half-existence of racemic warfarin ranges from 20 to 60 hours. The mean plasma half-life is pretty nearly 40 hours, and the span of impact is two to five days.10 Thus, the most extreme impact of a measurements happens up to 48 hours after organization, and the impact waits for the following five days.
7. Why was an INR ordered for TM? What is the desired range?
8. What serious adverse reaction could result with prolonged use or large doses os warfarin?
8. What patient teaching interventions should the nurse include? List 3 interventions.
blood needs to be verified whether your “International Normalized Ratio” (INR) is typical for your conclusion. The most widely recognized extent is 2 to 3, yet now and again the reach needs to be 2.5 to 3.5. For somebody not taking warfarin, a typical INR is around 1. – See more at:
9. Months later, TM has hematemesis. What nursing action should be taken?
Endoscopy is a discriminating early intercession that can be utilized to secure the wellspring of dying, and it additionally offers restorative choices. Blood misfortune adding up to six units in 24 hours is normally viewed as “monstrous.” If draining can’t be controlled by method for endoscopy, further intercessions with catheter-coordinated embolotherapy or surgery may be justified.
Critical Thinking Case Study Chapter 46
JH had a myocardial infraction ( MI) 3 years ago. HE was prescribed gemfibrozil(Lopid) 600 mg, twice daily, before meals. His cholesterol remained between 220 and 240 mg/dl, and his LDL was 140 mg/dl.His anticholosterol drug was changed to simvastatin ( Zocor) 20 mg/day in the evening.
1. How does simvastatin differ from gemfibrozil?
Gemfibrozil oral , simvastatin oral . Either increases the level of the other by added drug effects. Should not be taken with other lipid-lowering drugs that can cause muscle damage (myopathy)
2. Why do you think JH`s cholesterol drug, gemfibrozil, was changed to simvastatin?
After gemfibrozil treatment, the insulin focus was expanded amid the significant piece of the intravenous glucose resilience test (IVGTT) and amid the hyperinsulinemic euglycemic clasp. Comparable yet less professed heights were brought about by simvastatin.
3. While JH is taking simvastatin, which group of serum levels should be monitored?
Builds the rate at which the body expels cholesterol from blood and diminishes generation of cholesterol by restraining the catalyst that catalyzes an early rate-restricting venture in cholesterol union.
4 How lolg after JH took simvastatin should his cholesterol and lipoproteins be check?
Simvastatin is in a gathering of medications called HMG CoA reductase inhibitors, or “statins.” It diminishes levels of “awful” cholesterol (low-thickness lipoprotein, or LDL) and triglycerides in the blood, while expanding levels of “great” cholesterol (high-thickness lipoprotein, or HDL).
5. What is the maximum does for simvastatin?
Normal dosage range : 5 to 40 mg orally once a day at night . Patients with CHD or at high danger of CHD: Starting dosage: 10 to 20 mg orally once a day at night began all the while with eating routine and activity
6. JH complains of muscle pain and muscle weakness. What might this indicate.
Myocardial dead tissue (MI) or intense myocardial localized necrosis (AMI), normally known as a heart attack, happens when blood stream stops to a piece of the coronary corridor in the heart, creating ischemia to the heart muscle. The most well-known manifestation is midsection torment or uneasiness which may go into the shoulder, arm, back, neck, or jaw
7. Could JH receive both gemfibrozil and simvastatin? Explain your answer
Utilizing gemfibrozil together with simvastatin is not suggested. Joining these medicines can expand the danger of reactions, for example, liver harm and an uncommon however genuine condition called rhabdomyolysis that includes the breakdown of skeletal muscle tissue.
8 JH is on vacation and does not have enough simvastatin tablets. What should he do?
Alternatives for simvastatin tablets include Bile acid sequestrants, Nicotinic acid, Fibrates etc.
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