Pharmacology Antihypertensives #9

Question

The nurse is caring for a patient who has right-sided heart failure, and is scheduled to receive the second dose of bumetanide. Prior to administration of the drug, assessment of the patient reveals a marked decrease from 4+ to 1+ ankle edema, neck distention is less than earlier, and the patient lost 3 pounds in 24 hours. What action should the nurse take?

Answers

  1. Hold the bumetanide
    • Rationale:

      This answer is not correct because the patient still has symptoms that need to be treated (edema, JVD). Effectiveness of bumetanide treatment for a patient with right-sided heart failure is reflected by decrease in edema, jugular vein distention, and loss of weight. Treatment should continue and symptoms are monitored if the medication is reflecting effectiveness. Electrolyte levels, particularly potassium levels, should be carefully monitored while the patient is on bumetanide.

  2. Give the bumetanide early
    • Rationale:

      This answer is not correct because bumetanide should be given as directed, not earlier than prescribed. Administering the bumetanide earlier than prescribed could cause fluid to be removed from the body too quickly or excessive electrolytes removed too quickly, causing fluid or electrolyte imbalance.

  3. Notify the physician
    • Rationale:

      This answer is not correct because the physician does not need to be notified unless requested by the physician. The medication is performing its action as expected. The health care provider is not contacted unless the bumetanide is not working as desired. Effectiveness of bumetanide treatment for a patient with right-sided heart failure is being reflected by the decrease in edema, jugular vein distention, and loss of weight.

  4. Give the scheduled dose
    • Rationale:

      This answer is correct because bumetanide treatment should continue since it is reflecting effectiveness. Effectiveness of bumetanide treatment for a patient with right-sided heart failure is being reflected by the decrease in edema, jugular vein distention, and loss of weight.

Overview

Bumetanide is a diuretic used to decrease fluid in the patient with heart failure. Effectiveness of treatment for a patient with right-sided heart failure is reflected by decrease in edema, jugular vein distention, and loss of weight.

Explanation

The nurse should give the medication as prescribed since the desired effect is to reduce ankle edema and prevent it from occurring. There is no reason to hold the medication, give it early, or to notify the HCP.

Learning Outcomes

Bumetanide is a loop diuretic prescribed to decrease symptoms associated with heart failure to help increase cardiac output. The fluid volume overload is the main concern in a patient with right-heart failure. Symptoms include edema (facial, general, peripheral), jugular vein distention, and increased fluid weight. Effectiveness of bumetanide treatment for a patient with right-sided heart failure is reflected by decrease in edema, jugular vein distention, and loss of weight. Treatment should continue and symptoms are monitored if the medication is reflecting effectiveness. Electrolyte levels, particularly potassium levels, should be carefully monitored while the patient is on bumetanide.

Test Taking Tip

Calling the health care provider is not appropriate if prescribed treatment is working as expected. The health care provider should be notified if the patient is experiencing a sudden decline in health or if an assessment or diagnostic test reflects a significant change that could be detrimental to the patient, if not acted upon.

Video Rationale