30.8: Chapter 19
Unfolding Case Study
1. Findings from this case study that may indicate a fluid imbalance include elevated blood pressure, elevated heart rate, pitting edema in the lower extremities, crackles in lungs, and dyspnea.
2. Based on the findings listed in question 1, it is likely the patient is experiencing FVE. The extra fluid is accumulating in the lungs and interstitial spaces, leading to crackles in the lungs and peripheral edema, respectively. Additionally, with more fluid circulating in the body, the patient is likely to experience increased blood pressure and elevated heart rate as the body attempts to pump the extra blood through the body.
3. The patient is experiencing fluid excess, which results in an increased cardiac output. The formula for cardiac output (CO) is CO = SV × HR, where SV = stroke volume and HR = heart rate. We know the patient has an elevated heart rate (tachycardia) and an increased stroke volume (from high blood pressure and fluid excess), so if you plug that information into the formula, you get an elevated cardiac output. This can be a good compensatory mechanism for the body at first, but eventually the heart will tire out, resulting in inadequate cardiac output. Additionally, the patient is experiencing an increase in preload, or the amount of blood being brought to the heart.
4. Because the patient is experiencing fluid excess, the diuretic is ordered to rid the body of some of the extra fluid. This will decrease the preload, thus decreasing the amount of blood being brought back to the heart. This decreases the workload of the heart and, hopefully, also will improve the patient’s respiratory status.
5. The nurse should monitor serum sodium, chloride, and potassium levels closely as administration of diuretics may increase their excretion from the body. Rapid shifts in any of these electrolytes can have life-threatening effects, so it is imperative that the nurse monitor these values daily, or more frequently, as ordered by the treating clinician.
6. The nurse would expect to see an increase in urination after administration of the furosemide. With that, the nurse would also expect to see a decrease in blood pressure, improvement in lung sounds and oxygenation status, and less peripheral edema. The nurse would also expect to see some daily weight loss that corresponds to the amount of fluid being excreted as urine, if the interventions were successful.