Question

While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide [Lasix], digoxin, and spironolactone [Aldactone]. A diet history reveals the use of salt substitutes. The patient is confused and dyspneic and complains of hand and foot tingling. Which is an appropriate nursing action for this patient?

a. Contact the provider to request orders for an electrocardiogram and serum electrolyte levels.

b. Evaluate the patient's urine output and request an order for intravenous potassium.

c. Hold the next dose of furosemide and request an order for intravenous magnesium sulfate.

d. Request an order for intravenous insulin to help this patient regulate extracellular potassium.

Answer 1

The appropriate nursing action for the patient taking furosemide, digoxin, and spironolactone, and presenting with symptoms of electrolyte imbalance would be to contact the provider for orders of an ECG and serum electrolyte levels testing to assess any electrolyte imbalances and guide further treatment.

Step-by-step explanation:

Considering the patient is on furosemide (a loop diuretic), digoxin, and spironolactone (a potassium-sparing diuretic), and is using salt substitutes (often high in potassium), their symptoms of confusion, dyspnea, and hand and foot tingling suggest possible electrolyte imbalance. The combination of medications can cause both hypokalemia and hyperkalemia, as well as impact other electrolytes like magnesium. Salt substitutes might exacerbate hyperkalemia, as they are often high in potassium, which affects the heart and neuromuscular functions.

Given the signs and symptoms, an appropriate nursing action would be: a. Contact the provider to request orders for an electrocardiogram and serum electrolyte levels. An ECG would assess any cardiac arrhythmias potentially caused by electrolyte imbalances, and serum electrolyte testing would provide definitive data on the patient's potassium level as well as magnesium, calcium, and other relevant electrolyte levels. These findings would guide further treatment and shed light on whether the tingling sensation is due to hypocalcemia or another imbalance.

This patient's presentation does not strongly suggest the immediate need for potassium supplementation without further information, which disfavors choice b. Without knowing the current levels of magnesium, holding furosemide and providing magnesium sulfate (choice c) could be premature, and there's no current indication that this patient has hyperkalemia requiring intravenous insulin (choice d).