A 53-year-old presented in the emergency department reporting shortness of breath, fatigue, and abdominal bloating with pain over the last 4 days. The client received furosemide 40 mg IV and supplemental oxygen prior to transfer to the cardiac intensive care unit.
Admission Laboratory Values
|
Laboratory Test |
Normal Range |
Patient Value |
|
Serum Potassium |
3.5 to 5.0 mEq/L |
4.4 mEq/L |
|
Serum Creatinine 41 to 61 years |
Male 0.6 to 1.3 mg/dL Female 0.5 to 1.1 mg/dL |
1.46 mg/dL |
|
BUN Blood Urea Nitrogen |
10 to 20 mg/dL |
27 mg/dL |
|
Serum Sodium |
135 to 145 mEq/L |
139 mEq/L |
During the first 24 hours of admission, an additional dose of furosemide 40 mg was administered that resulted in 2400 mL of urine output. Client reported a lessening of dyspnea as well as an improvement of abdominal symptoms. Home medications including hydrochlorothiazide, spironolactone, carvedilol, and lisinopril were continued as previously prescribed.
Subsequent Laboratory Values (24 hours Later)
|
Laboratory Test |
Normal Range |
Patient Value |
|
Serum Potassium |
3.5 to 5.0 mEq/L |
3.8 mEq/L |
|
Serum Creatinine 41 years to 61 years |
Male 0.6 to 1.3 mg/dL Female 0.5 to 1.1 mg/dL |
1.87 mg/dL |
|
BUN Blood Urea Nitrogen |
10 to 20 mg/dL |
27 mg/dL |
|
Serum Sodium |
135 to 145 mEq/L |
142 mEq/L |
Based on the comparison of admission and subsequent laboratory values, ___1___ presents a major concern for ___2 _____ and requires ___3 ____ (Please fill in the blanks)
|
Laboratory Values (Option 1) |
Concern (Option 2) |
Required Intervention (Option 3) |
|
A. Serum Potassium |
A. Increase in glomerular filtration |
A. Discontinuation of lisinopril |
|
B. Serum Creatinine |
B. The onset of acute kidney injury |
B. Decrease of hydrochlorothiazide dosage |
|
C. BUN |
C. Exacerbation of hypertension |
C. Decrease of spironolactone dosage |
|
D. Serum Sodium |
D. Exacerbation of congested heart failure (CHF) |
D. Discontinuation of furosemide |
Provide a written up rationale (paragraph) for each of your choices- following the rubric!
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