Mrs. S. has been brought to the emergency department (ED) with chief complaints of increasing shortness of breath, coughing, and mild substernal pressure. Her husband called the paramedics when she complained she "cannot breathe." Mrs. S. is currently on a Venturi mask with an inspired oxygen fraction (Fioz) of 0.50. Her husband states she is a 66-year-old housewife with a history of coronary artery disease, arrhythmia, and a recent hospitalization for 3 weeks, resulting from an anterior wall myocardial infarction (MI); she has been out of the hospital for a month. Physical examination reveals a heart rate of 158 beats/min, blood pressure of 110/70mm Hg, and a Spo, of 93% on the Venturi mask. Breath sounds reveal inspiratory crackles from the bases up to the midchest, with mild expiratory wheezes. Her respiratory rate is 34 breaths/min, with some paradoxical respirations noted. Pitting edema is present in the ankles, no clubbing or cyanosis is noted, and her skin is cool and diaphoretic. There is jugular vein distention noted.
Mrs. S. has been admitted to the cardiac care unit. A portable chest radiograph taken on admission in the ED has now been returned and reveals cardiomegaly, as well as bilateral pulmonary vascular engorgement with interstitial and alveolar edema. She is diagnosed with congestive heart failure.
1. What drug would be beneficial in helping remove fluid from the patient's lungs?
2. Thirty minutes after giving 40 mg of Lasix, diuresis has not occured, What would you now recommend?
it has been 2 hours since Mrs. S. was admitted to the cardiac care unit. She is resting more comfortably and is on a nasal cannula at 3 L/minute. Because of the medications she is currently receiving, laboratory tests are obtained with the following results:
Potassium: 2.5 mEq/L (normal: 3.5-5.0 mEq/L)
Sodium: 140 mEq/L (normal: 136-145 mEg/L)
Chloride: 87 mEq/L (normal: 95-105 mEg/L)
Glucose: 125 mg/dL (normal: 90-150 mg/dL)
3. On the basis of this finding, what would you recommend?
4. What acid- base imbalance is likely to occur with these chemistry results?