Mr. Brown has received Lasix 40mg IVP. Three hours later he reports significantl

Question

Mr. Brown has received Lasix 40mg IVP. Three hours later he reports significantly less SOB, has faint crackles but no wheezing throughout the lung fields, he continues to cough but raises clear thin sputum, and his weight is 97.8kg. His vital signs are: blood pressure 66/42 mm Hg, heart rate 118 bpm, respiratory rate 242 breaths/min, and temperature 97.6°F. Mr. Brown now complains of dizziness with standing and position changes and had a near syncopal episode when attempting to get out of bed and go to the bathroom to urinate. He is still pale, cold, and clammy and is reporting extreme fatigue.

a. What has contributed to Mr. Brown’s current symptoms (include modifiable and non-modifiable risk factors)?

b. Is Mr. Brown’s showing any signs of compensation? What mechanisms exist (or doesn’t) that can help this patient with the ability to compensate? Why or why not?

c. What role does Mr. Brown’s fluid and electrolyte status have on his current presentation and his ability to perfuse?

d. What are the nurse’s priority(ies) of care for Mr. Brown based on the above information and his current status?

Explanation / Answer

a) Contributes to current symptoms:

Hypotension is said to be present when the blood pressure falls below 90/60mm of Hg. It is an abnormal condition in which the blood pressure is not adequate for normal perfusion and oxygenation of vital organs. That leads to the current symptoms like decrease BP(hypotension), increased respiratory rate, dizziness with standing and position changes and syncopal episode when attempting to get out of bed and go to the bathroom to urinate, and looks pale, cold, clammy, exterme fatigue. The modifiable risk factors for orthostatic hypotension are, dehydration, alcohol drinking, prolonged bed rest, medications. The non modifiable risk factors are old age above 65 years. Baroreceptors near heart and neck arteries that regulate blood pressure can slow as age progresses. It also may be harder for an aging heart to beat faster and compensate for drops in blood pressurre. Some heart diseases like valvular problems, diseases that cause neuropathy such as diabetes, increase the risk of low blood pressure.

b) Mr Brown shows some signs of compensation like increased respiratory rate, temperature to combat to normal regulation. Homeostasis of the internal mechanism to regulate fluid and electrolyte balance and the nervous system regulates homeostasis by sensing system deviations and sending nerve impulses to appropriate organs. The endocrine system uses the release and action of hormones to maintain homeostasis.

c) Role of Mr Brown fluid and elecrolyte status :

The fluid and electrolyte status shows that the bodys ability to perfuse to each and every organ.It plays an important role in maintaing the homeostasis. Fluid volume defict could result in dehydration of body tissues. That shows pale calmy skin, cold and report fatigue. Due to decreased fluids, it shows hypovolemia, dizziness and syncope.

d) Nurses priority of care:

-The nurse should monitor for fluid I and O chart atleast every 8 hrs

- Assess the weight daily

-The BP is of lower and it needs immediate attention.

-Fluids and electrolytes to be administered to maintain homeostasis.

-Vital signs should be monitored closely

-Maintain skin and tongue turgor

-Administer oral and paraenteral fluids to correct the deficit

-Hypovolemia and hyponatriemia should be monitored closely

-Provide oral rehydration solutions like fluids, glucose, and electrolytes in solutions that are easily absorbed

-The nurse must encourage intake of electrolytes that are of deficient.

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