Critical Thinking A 53-year-old presented in the emergency department reporting shortness of breath, fatigue, and abdominal bloating with pain over the last 4 days. The client received furosemide 40 mg IV and supplemental oxygen prior to transfer to the cardiac intensive care unit.
Admission Laboratory Values
Laboratory Test
Normal Range
Patient Value
Serum Potassium
3.5 to 5.0 mEq/L
4.4 mEq/L
Serum Creatinine 41 to 61 years
Male 0.6 to 1.3 mg/dL
Female 0.5 to 1.1 mg/dL
1.46 mg/dL
BUN Blood Urea Nitrogen
10 to 20 mg/dL
27 mg/dL
Serum Sodium
135 to 145 mEq/L
139 mEq/L
During the first 24 hours of admission, an additional dose of furosemide 40 mg was administered that resulted in 2400 mL of urine output. Client reported a lessening of dyspnea as well as an improvement of abdominal symptoms. Home medications including hydrochlorothiazide, spironolactone, carvedilol, and lisinopril were continued as previously prescribed.
Subsequent Laboratory Values (24 hours Later)
Laboratory Test
Normal Range
Patient Value
Serum Potassium
3.5 to 5.0 mEq/L
3.8 mEq/L
Serum Creatinine
41 years to 61 years
Male 0.6 to 1.3 mg/dL
Female 0.5 to 1.1 mg/dL
1.87 mg/dL
BUN
Blood Urea Nitrogen
10 to 20 mg/dL
27 mg/dL
Serum Sodium
135 to 145 mEq/L
142 mEq/L
Based on the comparison of admission and subsequent laboratory values, ___1___ presents a major concern for ___2 _____ and requires ___3 ____ (Please fill in the blanks)
Laboratory Values (Option 1)
Concern (Option 2)
Required Intervention (Option 3)
A. Serum Potassium
A. Increase in glomerular filtration
A. Discontinuation of lisinopril
B. Serum Creatinine
B. The onset of acute kidney injury
B. Decrease of hydrochlorothiazide dosage
C. BUN
C. Exacerbation of hypertension
C. Decrease of spironolactone dosage
D. Serum Sodium
D. Exacerbation of congested heart failure (CHF)
D. Discontinuation of furosemide
Provide a written up rationale (paragraph) for each of your choices- following the rubric!
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