Case Study Potassium Sparing Diuretic

The role of diuretics in heart failure is to reduce the fluid retention by diuresis (1). Patient should be monitored closely to prevent over diuresis that will subsequently lead to hypotension and renal impairment. Diuretic used is commonly associated with hypokalemia (1). Thus, additional potassium needs to be given concurrent to diuretic treatment (1). Patient’s daily weight must be recorded and aimed for reduction of body weight >4.5 kg in 5 days after treatment (7). Angiotensin converting enzyme inhibitor (ACE-I) is a first line agent in treating heart failure, especially when there is evidence of reduced in ejection fraction <40% as it improve survival rate of patient (1). Patient needs to be advised regarding side effects of the drug which are, dry cough, hypotension, renal insufficiency, hyperkalemia and angioedema. Antihypertensive agents that can be given in patient with heart failure are beta blocker, ACE-I and aldosterone antagonist. If the blood pressure is persistently high despite treatment with beta blocker, ACE-I and ARB, calcium channel blocker such as amlodipine can be added as this drugs has negative inotropic effect

Maureen shows clinical manifestations such as hypotension (BP 80 mmHg systolic), tachycardia (HR 120 bpm and irregular), tachypnea (Resps 28 bpm), SaO2 unreadable, capillary refill time >4secs, temp 36.5°C (core) indicating the signs of hypovolaemia (Perner & Backer, 2014, p. 614). With the reference of Mrs. Hardy’s medical condition, such as arthritic knees and atrial fibrillation (INR 2.7), she is under diclofenac Acid 50mgs PO BD and warfarin 2mgs PO mane respectively (Jordan, 2010, p. 567; Zacher, et al., 2008, p. 930). Diclofenac is a

541). Interventions should be rendered continuously, promptly and appropriately as it can cause life-threatening complications (Holt 2009, p. 26). Apparently, the patient is stable, but continuous assessment and management should be done to avoid recurrences of untoward signs andsymptoms and prevent potential complications. Firstly, continuous assessment and vital signs should be done and these include blood pressure, cardiac rate, respiration, venous distention and skin turgor to assess possible occurrence of fluid overload as a result of rapid administration of large fluid that is often needed to treat the patient with DKA (Smeltzer & Bare 2004 p. 1185). Aside from this, documentation of fluid intake and output should be monitored and documented to assess for circulatory overload and renal function (Holt 2009, p. 61). Significantly, it is integral in the provision of continuous care that nurses reassess the factors that may have contribute or led to DKA, and educate the patient and his family about strategies to prevent its recurrences (Smeltzer & Bare 2004 p. 1186; Lemone, Burke & Bauldoff 2011, p. 551).

NH hospitalization record reveals a medical history of a non-injurious stroke, numerous episodes of sickle cell crisis, acute chest syndrome and chronic asthma. NH is prescribed a daily regimen of medications including a daily dose of 15,00 mg hydroxyurea, 1 mg folic acid for his SCD and 44 mcg of inhaled fluticasone for his asthma. Currently, while suffering from sickle cell crisis, NH is prescribed oxycodone 5mg, Toradol 21 mg IV solution, acetaminophen, and morphine as well as a continuous IV drip of D5 ½ NS, KCL. Due to the opioids and level of pain NH has endured the last 4 days (since beginning of crisis) he is exhausted and considered a fall risk due to his fatigue and reports that he naps off and on throughout the day and only gets out of bed to use the

During the discharge process, Mr. K was instructed to follow-up with his primary care provider. The inpatient team also gave Mr. K prescriptions for a new anti-hypertensive medication. Sadly, they did not provide any instructions about his previous anti-hypertensive drugs. As a result, Mr. K continued to take the old and the new anti-hypertensive medications. Since his next appointment was within three weeks, he decided to wait instead

Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.

Pharmacological treatments with diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or aldosterone antagonist, and beta-blockers are essential for the treatment of heart failure and are effective in improving symptoms of heart failure and patient well-being. Diuretics are administered to help get rid of the excess fluid that helps improve breathing associated with shortness of breath, at rest or on exertion. Diuretics provide relief from symptoms and signs of pulmonary and venous congestion by promotion of fluid loss through the kidneys. Diuretics, for example, Furosemide helps improve breathing status, but monitoring patients for dehydration and kidney problems is crucial. Patient education is essential to ensuring medication adherence and early identification of adverse effects and potential for drug interactions.

Clinical studies recently revealed a dual avenue of importance in the relationship of older felines and proper potassium levels. Hypokalemia, which is an insufficient level of blood potassium, has been found to be common in mild form in older felines. It is most commonly associated with inactivity, lack of exercise, and lethargic behavior in these older cats. Additionally, it is also associated with poor appetite, bad conditions or the coat and skin, and the occurrence of anemia.

In addition, Sharon has hypotension, which could also be related to the side effects of medications such as enalarapril, digoxin and frusemide (Skidmore-Roth, 2013).

Elevated blood pressure, blood pressures at home, however, have been excellent. She has had side effects on both atenolol as well as losartan. Given that her blood pressures are so well controlled at home and it is good today, we will hold on starting her on any blood pressure medications. She will continue to monitor her blood pressure.

There are a plethora of treatments available for patients with heart failure including but not limited to diuretics, ACE inhibitors, angiotensin receptor blockers, and oral nitrates. The Vasodilator heart failure (V-HEFT) studies show that enalapril has less cumulative mortality among study participants when compared to patients taking a combination of isosorbide dinitrate and hydralazine. (MGMT) This is not to say that the combination of isosorbide dinitrate and hydralazine is not efficacious because when compared to placebo, mortality rates improved with the combination treatment.

Urinary System: Patient states that she urinates about 4 times a day without urgency. She denies having nocturia, dysuria, polyuria or oliguria, hesitancy or straining, narrowed stream, inconsistence, or pain in flank groin, suprapubic region, or low back. She states that her urine is clear, and it does not present hematuria. In order to avoid urinary tract infections, she states that she drinks about three liters of water every day. She had a UTI at age 18.

The assessment of Mrs. Baker should include vital signs including pulse oximetry. Given her difficulty in breathing, lung sounds should be auscultated. Because she is on two different medications that could affect blood pressure, lisinopril and hydrochlorothiazide (HCTZ), hypotension could be one cause of her collapsing. In addition to vital signs, decreased peripheral pulses and capillary refill can also be indicators of hypotension. Also, because HCTZ is a diuretic, dehydration should be considered. Since she was in her backyard when she collapsed, it could be that

According to the blood pressure in the assessment, M.K. has stage one hypertension. It was noted that she is currently being prescribed Lasix and Lotensin to help with her high blood pressure. Lotensin, also known as Benazepril, is an ACE-inhibitor, or angiotensin-coverting enzyme inhibitor. These types of drugs play an important role in the RAAS (which stands for renin-angiotensin-aldosterone system). Arterial blood pressure is regulated and accomplished through neural, hormonal, and renal interaction and is in tune with the homeostatic fluid volume of one’s body. The balance of sodium and water is performed by the kidneys and the renin-angiotensin-aldosterone system is the main regulator of fluid volume in the body. An increase of extracellular fluid increases vascular resistance, which in turn leads to increased arterial blood pressure. The kidneys will then sense this pressure change and in order to compensate, will promote sodium and water loss through micturition. Sodium intake is directly proportional to arterial blood pressure and since the kidneys cannot get rid of sodium as fast as water, higher levels are expected. As sodium increases serum osmolality triggering the hypothalamus to act as the regulator by signaling the posterior pituitary gland to

Ryan is currently on Digoxin 200 micrograms and Furosemide 10 mg q day. He is prescribed Digoxin because this medication increases overall cardiac output as well as slowing the heart rate. This is good for Ryan, because at this point he is not receiving the appropriate amount of output needed for his growth and development. Furosemide is a diuretic that treats fluid retention as well as hypertension. This is important because when there is a defect with the heart, pulmonary issues may occur when fluid retention begins. Also, Ryan is currently predisposed to hypertension because of his condition.