[Your Name Appears here]
[Your section appears here]
[Professor’s name appears here]
[Date Appears here]
QUESTION 1:
PART A:
Based on the information provided by the client about her medications are complete with few exceptions. The client mentioned that she is taking furosemide 40mg twice a day and then mentioned that she is taking lasix 60mg once a day in the morning. It is noteworthy that lasix and furosemide are one and the same thing and lasix is only the generic name for furosemide which is a loop diuretic. Therefore, patient is at risk of developing volume depletion and electrolyte imbalance. Similarly, tramadol is prescribed to the patient but the time, dosage, potency and route of administration is not mentioned making it impossible to administer the drug to the patient. Furthermore, route of administration of captopril, and ciprofloxacin are not mentioned.
PART B:
Furosemide is a loop diuretic and it can cause volume depletion and hypokalemia. Both are equally fatal if not corrected. Similarly, tramadol is an NSAID and it can cause erosive gastritis or gastropathy if taken for a longer period. Therefore, it is very essential to know and understand the route, potency and dosage of these medicines before administering them.
PART C:
Furosemide is a loop diuretic that is given to patients with fluid overload like congestive heart failure. In this case, sufficient information is not available as to why this patient is receiving a loop diuretic but few therapeutic uses of furosemide are:
Congestive heart failure
Pulmonary edema
Ascites secondary to liver failure
Anti-hypertensive
In cases of hypercalcemia
PART D:
She is taking a Non steroidal anti inflammatory drug (NSAID) for her arthritis pain. The only possible drug interaction furosemide can have is with tramadol.
QUESTION 2:
Furosemide is a diuretic or commonly known as “water pill”. It increases water excretion from the body in the form of urine. It does this by inhibiting the reabsorption of sodium and chloride in the distal tubule and loop of henle. The large sodium concentration in the tubules draws water and thus cause dieresis. Increased dieresis might have caused the tendency for millie to wake up every now and then for micturation which puts her at a great risk for falls. Its adverse effects include deranged liver enzymes, diarrhea, constipation, anaphylactic reaction, tinnitus, parasthesia, hearing loss, hyperglycemia and hyperuricemia.
QUESTION 3:
Increased dieresis might have caused the tendency for Millie to wake up every now and then for micturation which puts her at a great risk for falls. Increased dieresis also causes sleep disturbance which is another risk factor for the risk of fall in geriatric patients.
QUESTION 4:
She should be counseled regarding the possible side effects of this drug specially the one that has serious deleterious effects like volume depletion and electrolyte imbalance. Potassium supplementation may be considered in such patients. Furosemide is pro hyperglycemic drug which can further accentuate the diuretic effect of furosemide and thus increasing the urge to micturate frequently. She should be advised to take furosemide in the morning so that she can have disturbance free sleep at night time.
QUESTION 5:
Nurses play a very pivotal role in the implementation, execution and follow-up of pharmacologic interventions of patients. Learning and knowing how various drug acts and what are their undesirable effects are very crucial for justified and proper administration of drugs. This maximizes the beneficial outcomes for the patient, decrease health care cost and decrease mortality and morbidity.
