Caring for the Nguyens

Nam Nguyen has been prescribed the following medicines:

• Lisinopril 20 mg PO daily
• Hydrochlorothiazide 25 mg PO daily in the a.m.
• Metformin 500 mg PO before breakfast and lunch

Today he had blood drawn for analysis. Following are the electrolyte panel results:

Sodium 136 mEq/L

Potassium 3.0 mEq/L

Chloride 96 mEq/L

Bicarbonate 24 mEq/L

BUN 18 mg/dL

Creatinine 0.8 mg/dL

1. Review the lab results. Compare Nam's lab work with the established norms for these values. Based on the lab results, what kind of assessment questions would be appropriate to ask Nam?
2. Use your pharmacology text to review Nam's medications. Which, if any, of these medicines might be contributing to Nam's lab results?
3. What teaching would be appropriate for Nam?

 

Review the lab results. Compare Nam's lab work with the established norms for these values. Based on the lab results, what kind of assessment questions would be appropriate to ask Nam? Based on the labs there are particular electrolyte imbalance from the potassium and chloride so assessment question would be.

• assess if the patient experiences lethargy, fatigue or muscle weakness.
• assess for dry mouth and signs of dehydration
• assess patients urinary frequency and assess fluid intake and output

Use your pharmacology text to review Nam's medications. Which, if any, of these medicines might be contributing to Nam's lab results? The main drug that could affect Nam's electrolyte imbalance would the Hydrochlorothiazide 25 mg PO daily in the a.m.(diuretic) that is partnered with Lisinopril 20 mg PO daily (ACE inhibitor)

What teaching would be appropriate for Nam?

• Teach client how to check and monitor oral fluid intake and output and encourage patient to increase oral fluid intake if not contraindicated
• Educate patient about diet rich in potassium and chloride to help in electrolyte replacement
• Inform patient that electrolyte will be checked again for monitoring and progress
• Teach patient to comply in medication regimen if prescribed specially if related to electrolyte

Step-by-step explanation

Review the lab results. Compare Nam's lab work with the established norms for these values. Based on the lab results, what kind of assessment questions would be appropriate to ask Nam? Nam has slightly decreased chloride and potassium (Potassium 3.0 mEq/L, Chloride 96 mEq/L) and this is a common side effect of diuretics specially potassium wasting. It is important to consider these imbalances as it poses serious threat to the patient's body function related to electrolyte and acid base balance. So the questions we need to ask the patient for assessment are questions about signs and symptoms of hypokalemia, hypochloremia and dehydration.

Use your pharmacology text to review Nam's medications. Which, if any, of these medicines might be contributing to Nam's lab results? Lisinopril 20 mg PO daily is an angiotensin converting enzyme inhibitor even though it is not the one responsible for potassium wasting but it is partnered with Hydrochlorothiazide 25 mg PO daily in the a.m. which is a diuretic and is the one responsible for electrolyte wasting. Lisinopril is partnered to Hydrochlorothiazide to reverse some potassium wasting effect while decreasing the blood pressure, but still it seem to disregard the side effect of the thiazide and the patient is still losing electrolyte such as potassium. Metformin is an antidiabetic drug, that can lead to acid base imbalance or metabolic acidosis if taken above the therapeutic level, but the lab result did not show any abnormality related to metformin.

What teaching would be appropriate for Nam? Health teaching would focus on electrolyte and fluid replacement, specially if its a going home instruction, providing instruction about proper diet, intake and output monitoring, and observing signs of dehydration.