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Zorluk: ZorReduction of Risk Potential

During the morning medication pass at a long-term care facility, a practical nurse reviews the electronic health record of a resident diagnosed with heart failure. The resident is scheduled to receive oral doses of digoxin and furosemide. Morning laboratory results indicate a serum potassium of 3.1 mEq/L (3.1 mmol/L) and a serum digoxin level of 1.3 ng/mL (1.66 nmol/L). The resident's current vital signs are blood pressure 102/58 mm Hg, heart rate 94 beats per minute, and respiratory rate 18 breaths per minute. Which action should the nurse prioritize to minimize the risk of complications?

  1. Withhold the scheduled doses of both medications and immediately report the clinical findings to the supervising registered nurse.Cevap
  2. B
    Hold the furosemide due to the low potassium level, but administer the digoxin because its serum level is within the expected therapeutic range.
  3. C
    Administer both medications as prescribed, interpreting the mild hypotension and borderline tachycardia as expected baseline findings for heart failure.
  4. D
    Conduct a focused assessment for signs of digoxin toxicity and proceed with administration only if the resident denies nausea or visual halos.

Cevap

The practical nurse should prioritize withholding both the digoxin and furosemide and immediately escalating the abnormal laboratory and vital sign findings to the supervising registered nurse.
The correct answer involves withholding both medications and notifying the registered nurse. A serum potassium level of 3.1 mEq/L indicates hypokalemia (normal is 3.5-5.0 mEq/L). Hypokalemia significantly increases the myocardium's sensitivity to digoxin, placing the client at high risk for fatal dysrhythmias and toxicity, even when the serum digoxin level (1.3 ng/mL) is strictly within the normal therapeutic range (0.5-2.0 ng/mL). Furthermore, administering furosemide, a loop diuretic, would exacerbate the hypokalemia. The borderline vital signs (blood pressure 102/58 mm Hg, heart rate 94 bpm) may indicate early volume depletion or decreased cardiac output. The safest action within the practical nurse's scope is to withhold the medications and escalate the critical findings.

Adım Adım Çözüm

1
Analyze the morning laboratory results against normal reference ranges.
The potassium level of 3.1 mEq/L is critically low (hypokalemia). The digoxin level of 1.3 ng/mL is within the normal therapeutic range.
Identifying abnormal values is the critical first step in risk reduction.
2
Evaluate the pharmacological interactions between the prescribed medications and current laboratory values.
Furosemide causes potassium wasting, which will worsen the hypokalemia. Hypokalemia increases the risk of digoxin toxicity even at normal serum levels.
Understanding drug-lab interactions prevents the administration of potentially lethal medications.
3
Analyze the client's vital signs for early signs of decompensation.
The blood pressure of 102/58 mm Hg and heart rate of 94 beats per minute are borderline and may indicate volume depletion or early dysrhythmia.
Recognizing subtle physiological changes helps identify emerging complications.
4
Determine the appropriate nursing intervention within the practical nurse's scope of practice.
The nurse must withhold both medications to prevent patient harm and immediately notify the registered nurse.
Escalating critical findings ensures the client receives appropriate medical intervention and maintains patient safety.

Anahtar Kavram

Reduction of Risk Potential: Recognizing Critical Drug-Laboratory Interactions and Escalating Care
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Reduction of Risk Potential

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