A 65-year-old client is receiving a continuous intravenous infusion of furosemide for severe fluid volume overload. During the shift, the client becomes increasingly lethargic and reports profound muscle cramps. The nurse notes the client's blood pressure has dropped from 134/82 mmHg to 86/52 mmHg over the past two hours. An arterial blood gas (ABG) analysis reveals the following values: pH 7.53, PaCO2 43 mmHg, and HCO3 36 mEq/L. Which action should the nurse prioritize to mitigate the risk of further physiological decline?
- Discontinue the continuous furosemide infusion and immediately notify the healthcare provider.Cevap
- BCoach the client to breathe into a paper bag to resolve the uncompensated respiratory alkalosis.
- CElevate the head of the bed to a high-Fowler's position to decrease venous return and cardiac workload.
- DDocument the current findings as an expected therapeutic response to the aggressive diuresis.
Cevap
Discontinue the continuous furosemide infusion and immediately notify the healthcare provider.
The client is exhibiting clear signs of severe volume depletion and contraction alkalosis induced by aggressive diuresis. The marked hypotension, lethargy, and muscle cramps (suggesting hypokalemia) are critical indicators of impending hypovolemic shock. The ABG results confirm uncompensated metabolic alkalosis. The nurse's immediate priority must be to halt the diuretic infusion and alert the provider to obtain orders for fluid resuscitation and electrolyte replacement.
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Anahtar Kavram
Recognizing and mitigating impending hypovolemic shock and metabolic alkalosis caused by aggressive diuretic therapy.
Tahmini Süre:1m 30s