Katherine Crosland, a 79-year-old widow, has lived alone for the past 5 years. Although her son and daughters all reside in distant locations, they check on her at least weekly by telephoning. Katherine is fairly independent; however, she does not drive, and is dependent on a neighbor to get her groceries and medications. Three years ago, Katherine was hospitalized for an MI, which resulted in heart failure. She is adherent with her medications, which include digoxin (Lanoxin) 0.125 mg daily, furosemide (Lasix) 20 mg/day, and potassium supplements (K-Dur) 20 mEq daily. Recently Katherine’s neighbor went on an extended, out-of-town trip. Katherine was certain that she had enough of her medicine to last through that time. However, before the neighbor returned, Katherine discovered she had miscalculated her potassium supplement and only had enough for 10 days. Katherine figured that because the potassium was only a “supplement,” she would be able to wait until her neighbor returned to get the medication refilled. Today, she presents to the clinic with generalized weakness and fatigue. She has lost 3.6 kg (8 lb) since her last clinic visit 6 weeks ago. Her blood pressure is 104/62 mmHg, her heart rate is 98 beats/min, and she has a slightly irregular, respiratory rate of 20 breaths/min, and body temperature is 36.2°C (97.2°F). The blood specimen collected for diagnostic studies showed several outstanding findings such as a serum sodium level of 150 mEq/L and potassium level of 3.2 mEq/L. Katherine is diagnosed with dehydration and hypokalemia induced by diuretic therapy.
1. Discuss fluid and electrolyte imbalances related to the following diuretic therapies: a. Loop diuretics b. Thiazide diuretics c. Potassium-sparing diuretics d. Osmotic diuretics
2. What relationship exists between this patient’s diuretic therapy, digoxin therapy, and hypokalaemia?
3. What patient education should the nurse provide about diuretic therapy?