Critical Thinking Week 7
A 53-year-old presented in the emergency department reporting shortness of breath, fatigue, and abdominal bloating with pain over the last 4 days. The client received furosemide 40 mg IV and supplemental oxygen prior to transfer to the cardiac intensive care unit.
Admission Laboratory Values
| Laboratory Test | Normal Range | Patient Value |
| Serum Potassium | 3.5 to 5.0 mEq/L | 4.4 mEq/L |
| Serum Creatinine 41 to 61 years | Male 0.6 to 1.3 mg/dL
Female 0.5 to 1.1 mg/dL |
1.46 mg/dL |
| BUN Blood Urea Nitrogen | 10 to 20 mg/dL | 27 mg/dL |
| Serum Sodium | 135 to 145 mEq/L | 139 mEq/L |
During the first 24 hours of admission, an additional dose of furosemide 40 mg was administered that resulted in 2400 mL of urine output. Client reported a lessening of dyspnea as well as an improvement of abdominal symptoms. Home medications including hydrochlorothiazide, spironolactone, carvedilol, and lisinopril were continued as previously prescribed.
Subsequent Laboratory Values (24 hours Later)
| Laboratory Test | Normal Range | Patient Value |
| Serum Potassium | 3.5 to 5.0 mEq/L | 3.8 mEq/L |
| Serum Creatinine
41 years to 61 years |
Male 0.6 to 1.3 mg/dL
Female 0.5 to 1.1 mg/dL |
1.87 mg/dL |
| BUN
Blood Urea Nitrogen |
10 to 20 mg/dL | 27 mg/dL |
| Serum Sodium | 135 to 145 mEq/L | 142 mEq/L |
Based on the comparison of admission and subsequent laboratory values, ___1___ presents a major concern for ___2 _____ and requires ___3 ____ (Please fill in the blanks)
| Laboratory Values (Option 1) | Concern (Option 2) | Required Intervention (Option 3) |
| A. Serum Potassium | A. Increase in glomerular filtration | A. Discontinuation of lisinopril |
| B. Serum Creatinine | B. The onset of acute kidney injury | B. Decrease of hydrochlorothiazide dosage |
| C. BUN | C. Exacerbation of hypertension | C. Decrease of spironolactone dosage |
| D. Serum Sodium | D. Exacerbation of congested heart failure (CHF) | D. Discontinuation of furosemide |
Provide a written up rationale (paragraph) for each of your choices- following the rubric!
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