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SCENARIO: E.G. is a 73-year-old woman whose daughter brings her to…

 

SCENARIO: E.G. is a 73-year-old woman whose daughter brings her to see the health care provider because she has had a case of the “stomach flu,” with vomiting and diarrhea for the past three to four days and is now experiencing occasional light-headedness and dizziness. Her past medical history includes hypertension, hypercholesterolemia, and mild heart failure. She is taking: Digoxin 0.125 mg po daily. Captopril 25 mg po BID. Furosemide 40 mg po daily. Potassium chloride 20 mEq po daily. Atorvastatin 20 mg po at bedtime.

Subjective Data

Has been following a low sodium diet
Has been taking her medications except for the potassium chloride pill because it upsets her stomach.
Occasionally takes an extra “water pill” when her ankles are swollen

 

Objective Data

 

Physical Examination

Temperature 98.2° F, pulse 88, respirations 20, BP 138/86
Lungs clear to auscultation, breathing regular and unlabored
+1 edema bilaterally in ankles
Muscle strength in upper extremities normal and equal and in lower extremities weak
Sensation to all extremities normal

Diagnostic Studies

Lab values
Sodium             139.0mEq/L
Potassium         3.0mEq/L
Chloride           99.5 mEq/L
Total Ca 8.4
Mg 1.5
Phos 2.7
BiCarb.
Questions
Explain specifically how furosemide works in the kidney.
How would you assess E.G., for fluid volume deficit?
What IV fluids would you expect the physician to order?
How would you expect to replenish the potassium? Explain the rationale and include nursing interventions.
What symptoms does E.G., have that support hypokalemia?
SCIENCE
HEALTH SCIENCE
NURSING