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Zorluk: ZorPharmacological Therapies

A client admitted with an exacerbation of heart failure is scheduled to receive oral digoxin and oral furosemide. The client is also prescribed an annual influenza vaccine. Morning laboratory results indicate a serum potassium level of 2.8 mEq/L2.8\text{ mEq/L} (2.8 mmol/L2.8\text{ mmol/L}) and a serum digoxin level of 1.0 ng/mL1.0\text{ ng/mL} (1.28 nmol/L1.28\text{ nmol/L}). The client reports experiencing a new onset of muscle cramps, weakness, and a temperature of 101.2∘F101.2^\circ\text{F} (38.4∘C38.4^\circ\text{C}). Which actions should the practical nurse take? Select all that apply.

  1. Withhold the scheduled oral furosemide and notify the registered nurse.Cevap
  2. Withhold the scheduled oral digoxin dose due to the increased risk of toxicity.Cevap
  3. C
    Administer the influenza vaccine as prescribed to protect the client's compromised respiratory status.
  4. D
    Administer an intravenous push dose of potassium chloride to rapidly correct the electrolyte deficit.
  5. E
    Document the potassium level in the electronic health record and wait for the provider to review it during rounds.
  6. Auscultate the client's apical pulse for one full minute to assess for potential cardiac dysrhythmias.Cevap

Cevap

The practical nurse should withhold the scheduled oral furosemide, withhold the scheduled oral digoxin dose, and auscultate the client's apical pulse for one full minute.
The client presents with severe hypokalemia (2.8 mEq/L2.8\text{ mEq/L}). Administering furosemide, a potassium-wasting diuretic, would dangerously exacerbate this deficit. Furthermore, hypokalemia significantly increases the risk of digoxin toxicity, meaning digoxin must be withheld despite the serum level being in the therapeutic range. Because severe hypokalemia can cause fatal dysrhythmias, taking a full one-minute apical pulse is a necessary assessment action.

Adım Adım Çözüm

1
Analyze the client's morning laboratory values.
The serum potassium is critically low at 2.8 mEq/L2.8\text{ mEq/L}, while the digoxin level is therapeutic.
Identifying abnormal laboratory values is essential before administering related medications.
2
Evaluate the effects of the prescribed medications on the client's current status.
Furosemide depletes potassium, and low potassium increases the risk of digoxin toxicity. Additionally, the client's fever is a contraindication for the vaccine.
Understanding pharmacodynamics and contraindications prevents the administration of harmful medications.
3
Determine the appropriate nursing interventions within the practical nurse scope of practice.
The nurse must withhold the contraindicated medications, assess cardiac status via apical pulse, and immediately report findings to the registered nurse.
Ensuring client safety requires immediate action, physical assessment, and escalation of critical findings.

Anahtar Kavram

The practical nurse must integrate laboratory data with medication administration principles, recognizing that hypokalemia contraindicates potassium-wasting diuretics and increases the risk of digoxin toxicity, while acute febrile illness contraindicates immunizations.
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