CASE STUDY #2

Case Study # 2: Managing Fluid Overload with Diuretic Drugs

Instructions

Complete the following case study.  Students must handwrite their responses and upload to Canvas as a word doc or pdf file. 

Students must use resources and cite them in APA 7th edition format- click on link or go to the writing center for further assistance (APA Formatting and Style Guide (7th Edition) – Purdue OWL® – Purdue University.  Answers must include in-text citations to back up the responses.

The APA citation page is the ONLY thing that can be typed.  Do NOT use a citation machine as it can be incorrect formatting.

Sources must be within 5 years of the current date (evidence-based practice). Earliest date that is allowed = 2019

View the rubric below to know how the case studies will be graded. 

Assignment

Mr. Thompson is a 70-year-old Caucasian male who is admitted to the hospital with a diagnosis of congestive heart failure (CHF). He has a history of hypertension and was recently diagnosed with systolic heart failure. Mr. Thompson reports progressive dyspnea on exertion, orthopnea, and lower extremity edema for the past two weeks. His blood pressure (BP) readings are elevated, ranging from 160/100 mmHg to 180/110 mmHg.

Medical History:

1. Systolic heart failure diagnosed recently

Hypertension

Progressive dyspnea, orthopnea, and lower extremity edema

1. Current Medications:
2. Lisinopril 20 mg once daily for hypertension

Physical Examination:

Blood pressure: 175/102 mmHg

Heart rate: 90 bpm

Respiratory rate: 24 breaths per minute

Bilateral crackles on lung auscultation

• Lower extremity edema
• Laboratory Results:
• Elevated B-type natriuretic peptide (BNP): 800 pg/mL

Serum creatinine: 1.2 mg/dL

Electrolytes within normal limits

Assessment: Mr. Thompson is diagnosed with systolic heart failure exacerbation, and his hypertension needs to be managed to improve his symptoms and reduce fluid overload.

• Plan:

Diuretic Medication Adjustment: The physician decides to adjust Mr. Thompson’s diuretic regimen to address fluid overload.

Selection of Diuretic Agent: Considering his clinical presentation, the physician chooses a loop diuretic for its potent diuretic effect.

Monitoring and Symptom Management: Close monitoring of fluid balance, electrolytes, and symptom improvement is crucial. Adjustments to the diuretic dose may be necessary.

• Prescription: Furosemide (Lasix) 40 mg IV push, followed by 20 mg IV every 12 hours
• Questions for Students to Answer:
• Pathophysiology Understanding:
• Explain how systolic heart failure contributes to fluid retention and the development of symptoms such as dyspnea and edema.
• Diuretic Medication Knowledge:

Describe the mechanism of action of furosemide (Lasix).

What distinguishes loop diuretics from other diuretic classes, and why are they often preferred in heart failure management?

Patient Assessment and Monitoring:

• Identify at least 3 key assessments and monitoring parameters to evaluate the effectiveness and potential complications of furosemide in Mr. Thompson.
• Patient Education:
• What information will you provide to Mr. Thompson regarding his new diuretic medication, furosemide?

How will you educate him on signs of worsening heart failure and the importance of medication adherence?

Collaborative Care:

What other interventions or therapies might be considered in the collaborative care plan for Mr. Thompson?

For all of the questions, make sure you include a rationale for your answers and use in-text citations to backup your response.  This helps build critical thinking skills.