...since her discharge. 1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? The patient most likely failed to adequately apply the fluid and sodium restrction diet properly. Upon discharge teaching, she probably did not have an appropriate understanding of how much soidum to restrict in her diet, as well as what foods may be high in sodium. She also may not have an adequate understanding of what a "fluid" restriction diet entails. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. a. Pioglitazone: Side effects:Severe weight gain and water retention (edema) are both known to contribute to heart probelms. . 3. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work to reduce heart failure? (Select all that apply.) ACE inhibitors: a. prevent the conversion of angiotensin I to angiotensin II. b. cause systemic vasodilation. c. promote the excretion of sodium and water in the renal tubules. d. reduce...
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...temperature? When did you arrive at the home? When did you discover the bodies? Were the Underhill’s taking any medications? 3. Clint Underhill had taken a medicine called Lasix directly before he went into the hot tub. The Underhill’s were drinking wine in the hot tub and the tub seemed very hot to the paramedics. 4. Lasix, also called furosemide, is a water pill, used to reduce the swelling and fluid retention that can be caused by various medical problems such as heart or liver disease, and it is also used to treat high blood pressure. It causes the kidneys to get rid of unneeded water and salt from the body into the urine. Lasix can make the person taking it very dehydrated, so it is important to try staying hydrated. In addition, drinking too much alcohol affects many parts of the body. It can be especially harmful to the liver, the organ that metabolizes (breaks down) alcohol and other harmful substances. Alcohol not broken down by the liver goes to the rest of the body, including the brain. Alcohol can affect parts of the brain that control movement, speech, judgment, and memory. These effects lead to the familiar signs of drunkenness: difficulty walking, slurred speech, memory lapses, and impulsive behavior. 5. I believe the cause of Clint Underhill’s death was because of his medication, Lasix, the mixture of alcohol, and the overly hot water. One should...
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...Sarah Gray @02668478 Intro to Pharmacology Case Study 4 Chapter 41 The Furosemide (Lasix) which lessen the fluid volume by escalate the amount of electrolytes and water that the kidneys are getting rid of. When there is less fluid volume the blood pressure will go down. Since her blood pressure is decreasing, the rate of her heart beat will decrease, diminish the amount of work that the heart has to do, and lowering how much fluid has built up in the lungs. The nurse needs to know how fast Furosemide (Lasix) should be given, how it work with other intravenous liquids, and what Lasix’s concentration is. The Foley catheter was ordered so it would accurately measure how much fluid was being released due to the Lasix (furosemide). The nurse should look at her blood pressure, respirations, temperature, pulse, pulse ox, and pain. He or she should also look for sluggishness and unsureness which are signs of hyponatremia; hyperkinesis, uncontrollable muscle spasm, easily upset which are symptoms of hypochloremia; thromboembolism which can be indicated by pain in lower extremities, migraine, inability to breathe, change in level of consciousness, and pain in chest. The nurse needs to let the prescriber know that all though the client’s potassium level was normal it was low in the normal range at the time the labs were drawn, Lasix can cause a drop in potassium, chloride, and sodium. He or she also needs to find out if the patient is currently on a regimen containing digoxin...
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...Friday, 7pm Roma and Clint Underhill had both had a long day. They were the owners of a successful real estate company in San Diego. Each had several clients, and the strain of the current real estate market was getting to them. It had been an unusually cool day for January, with temperatures hovering around 45 degrees. On coming home they decided to relax in their hot tub with some wine. While Roma changed from her work clothes, Clint said that he would join her in the hot tub after he took his Lasix. Saturday, 8am “911… Please state your emergency.” “Oh, Oh, I… I… ” “Ma’am, please calm down and tell me the address.” “I think…, yes, OK, it’s… it’s 2560 Oak Creek Drive.” “What is the problem, please?” “I’m the maid for Mr. and Mrs. Underhill and… and I didn’t find them in the house when I came in this morning, so I looked around outside. I just found them in their hot tub out back. They are under the water. Please come, please come now!” “Yes, ma’am, I’m alerting the EMTs and an ambulance will be on the way. Please go out front and wait, so the paramedics can find the address quickly.” Saturday, 8:10am Paramedics Kavita Dickson and Larry Gonzales brought the ambulance to a stop at the end of a long driveway next to an impressive two-story mansion. The maid was on the front steps and quickly directed them to the back patio where the hot tub could be seen. Empty bottles of wine were on the ledge surrounding the hot tub. Kavita quickly climbed up the steps and saw the bodies...
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...discharged 10 days ago? If M.G. is currently following her fluid and salt restriction strictly but is still exhibiting the symptoms of fluid overload in heart failure, there was most likely an error in regards to medication teaching. She would have been prescribed a diuretic to eliminate the fluid that what giving her shortness of breath, edema and weight gain but if not taken correctly or at all this would explain why M.G. is still having these manifestations. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. . 3. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work to reduce heart failure? (Select all that apply.) ACE inhibitors: a. prevent the conversion of angiotensin I to angiotensin II. b. cause systemic vasodilation. c. promote the excretion of sodium and water in the renal tubules. d. reduce preload and afterload. e. increase cardiac...
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...of Mr. and Mrs. Underhill lie at the bottom of the tub which had a noticeably above average temperature. The couple was determined to have been dead long before the paramedics arrived. It was also mentioned that Mr. Underhill had taken Lasix before entering the hot tub. 2) Based on these observations the investigators should ask the maid why the hot tub was at an unsafe temperature. Other areas of concern include the medication Mr. Underhill was on, what time the maid got home, and how long the Underhill’s had been dead upon arrival. 3) The assumed physiological effects of this scenario include, blood alcohol level, the medication Lasix used to lower Mr. Underhill’s blood pressure, and the hazardous heat of the hot tub. 4) Alcohol causes hypertension, or an increased blood pressure, which in turn increases the risk of heart attack or stroke. It also acts to expand blood vessels and raise the body temperature to unsafe levels rapidly. Common side-effects of consuming alcohol in a hot tub include; loss of consciousness, heart attack, or injury due to fainting. Mr. Underhill’s medication Lasix, is classified as a water pill, which causes the kidneys to remove unneeded water and salt from the body through the process of urination. Lasix also makes those using it more susceptible to dehydration. Anyone on blood pressure medication should not enter a hot tub because of the blood pressure raising effects. Hot water temperatures can elevate body temperature inside the internal...
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...(Introductionwhat happened - from the case study:Roma and Clint went into hot tub with some wine. After the night, they were found dead.Before going into the hot tub, Clint took his Lasix medication. The temperature of the hot tubwas higher than it should be. BAL of the couple was 0.20. Roma weighted 120lb; Clintweighted 160lb. Time of death estimated at 2AM in the morning. There was a therapeutic(fair amount) level of Lasix in Clint’s blood, but none in Roma’s blood .TemperatureHot tub temperature can be no more than 104-106 degree Fahrenheit (40-41 degreeCelsius(more than 104-106 (40-41) can lead to heat stroke, heart attack nausea, stroke, braindamage, other illness and death, even in healthy adults. They might drown ..AlcoholAlcohol while in hot tub is very dangerous -The heat from the spa accelerates the effects of the alcohol and can lead tounconsciousness. -alcohol dehydrates the body, as does sweating in a hot tub--cause light-headedness,dizziness, nausea, heart palpation, confusion, weakness and even coma and death. -Drinking alcohol can cause dizziness, which can be aggravated by the high temperature ofa hot tub. dizziness may cause you to fall..and drown -the depressant effect of alcohol intake in combination with the high temperature of a hottub can cause you to fall asleep or pass out.---drowning -the heat of a hot tub expands your blood vessels (lowers blood pressure) and increasesyour body temperature (cause you to sweat--dehydration), as does drinking alcohol.combining...
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...found by the medical examiner was high but was not necessarily sufficient to cause their death, but was it a contributing factor? Sam knew that Lasix was used to treat high blood pressure and that both alcohol and heat will reduce blood pressure, but he was unsure about the mechanism. He decided to go to The University of Houston and talk to Rene Volenbach, a physiologist in the biology department. Renee patiently explained her answer to each of the following questions posed by the detective. Questions: 1. How does the body regulate blood pressure? * The body has certain mechanisms that help it keep a stable blood pressure or change it when needed. It contains sensors that monitor blood pressure within the walls of arteries that send input signals to the cardiovascular center which sends output signals to the heart and blood vessels to adjust accordingly. 2. What were the specific effects of the Lasix, hot water, and alcohol on the couple’s blood pressure? * Alcohol and Lasix medication should not be mixed due to the effects of sudden drop in blood pressure that could get to the point of orthostatic hypotension, which is caused by standing after sitting or lying down for a while. Other effects are feeling dizzy, light-headed, temporary loss of consciousness, and tachycardia. The hot water temperature, wine, and Lasix caused the body temperature to increase, blood pressure to drop, blood flow to decrease, and dehydration. 2. What could...
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...Case Study: The Hot Tub Mystery This case study describes how Clint & Roma Underhill were discovered dead in their hot tub. The day of their death was described as unusually cool (though it was only ~15ºC… must be nice to live in Desert Palm... ). Empty wine bottles were surrounding the couple, and when the ambulance personnel arrived they observed that the hot tub was very hot - 115ºF. Mr. Underhill had also been taking a drug known as Lasix. The following are the facts submitted by the medical examiner: * BAL (blood alcohol level) of the couple was 0.20 * Roma weighed 120 lbs; Clint weighed 160 lbs * There was a therapeutic amount of Lasix present in Mr. Underhill’s blood, but none in Mrs. Underhill’s. * The couples’ hot tub was unusually hot (should not be over 109ºC) Determining the cause of death: There are many pieces to this puzzle and when attempting to determine the cause of death for the couple, you must consider the following physiological affects: Lasix: * Diuretic used to treat congestive heart failure, edema (swelling of tissues) and hypertension (high blood pressure) * Increases circulation of blood through kidneys lowers blood pressure Blood alcohol level (BAL): * Concentration of alcohol in a person’s blood (mass per unit volume) * BAL ≥ 0.2% represents serious intoxication (over 0.08% is too drunk to drive!) Alcohol effects: * Include diuretic (increasing kidney output lower blood pressure) leading...
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...Part I—The Discovery Cast of Characters • Sam Garrison—Detective • Roma and Clint Underhill—The hot couple • Kavita Dickson and Larry Gonzales—EMT paramedics • Renee Volenbach—Physiologist in the Biology Department at Noletown University Friday, 7PM Roma and Clint Underhill had both had a long day. They were the owners of a successful real estate company in Desert Palm. Each had several clients, and the strain of the current real estate market was getting to them. It had been an unusually cool day for January, with temperatures hovering around 60 degrees. On coming home they decided to relax in their hot tub with some wine. While Roma changed from her work clothes, Clint said that he would join her in the hot tub after he took his Lasix. Saturday, 8AM “911… Please state your emergency.” “Oh, Oh, I… I… ” “Ma’am, please calm down and tell me the address.” “I think…, yes, OK, it’s… it’s 2560 Oak Creek Drive.” “What is the problem, please?” “I’m the maid for Mr. and Mrs. Underhill and… and I didn’t find them in the house when I came in this morning, so I looked around outside. I just found them in their hot tub out back. They are under the water. Please come, please come now!” “Yes, ma’am, I’m alerting the EMTs and an ambulance will be on the way. Please go out front and wait, so the paramedics can find the address quickly.” Saturday, 8:10AM Paramedics Kavita Dickson and Larry Gonzales brought the ambulance to a stop at the end of a long driveway next to an impressive...
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...Temperature Why was the hot tub set to such a dangerously high temperature? First, Roma and Clint had a very high BAL of 0.20. At that point their decision making would get very weak and they cannot stand up. So with the poor their poor decision, they could have set the temperature of the hot tub higher. Also, since the weather was colder than usual at 15 degrees Celsius, the water temperature could have been lower due to the cold air. How does water temperature affect core body temperature? If the water is cold the body will try to conserve heat and keep its homeostasis. If the water is hot the body will try to get rid of heat to keep its homeostasis. Hot tub water was hot at 45 degrees Celsius. Blood vessels will dilate near the surface of the skin. Sweat to cool down the body temperature Did the air temperature have an effect on water temperature? The air was about 15 degrees Celsius which is much colder than the hot tub temperature. So the air temperature would cool the water down. How does the body respond to 45 degrees Celsius? The body sweats to cool down and blood vessels dilate. Therefore lose water How does the body respond to 15 degrees Celsius? Blood vessels contract near surface. Muscles contract (shiver) When would heat stroke occur? Heat stroke occurs when the body over heats. Heat stroke occurs when the core body temperature is greater than 105 degrees Fahrenheit (40.5 degrees Celsius), with complications involving the central nervous system...
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...2. What were the specifi c eff ects of the Lasix, hot water, and alcohol on the couple’s blood pressure? 3. What could the body have done to reverse the decreasing blood pressure, if it had been possible? 4. Identify several procedures that might have helped save the couple if they had been found unconscious but still above water and alive. Essay Put yourself in the role of Detective Garrison. You must now write a report explaining what Renee might have said with regard to the above questions. You should use all of your knowledge about blood pressure and the information from this case to explain each of the following aspects of blood pressure and discuss their relation to the above questions. Describe the role of the nervous system, adrenal glands, kidneys and pituitary as appropriate to the relation of each of the seven factors listed below: 1. Peripheral resistance 2. Heart rate 3. Venous return 4. Stroke volume 5. Cardiac output 6. End systolic and diastolic2. What were the specifi c eff ects of the Lasix, hot water, and alcohol on the couple’s blood pressure? 3. What could the body have done to reverse the decreasing blood pressure, if it had been possible? 4. Identify several procedures that might have helped save the couple if they had been found unconscious but still above water and alive. Essay Put yourself in the role of Detective Garrison. You must now write a report explaining what Renee might have said with regard to the above questions. You should...
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...Detetive • Roma e Clint Underhill casal Kavita Dickson e Larry Gonzales-emt paramédicos • Renee Volenbach-fisiologista do Departamento de Biologia, Universidade Noletown. Sexta-feira, 19 horas Roma e Clint Underhill, ambos tiveram um longo dia. Eles são os proprietários de uma bem-sucedida empresa imobiliária em Desert Palm. Cada uma tinha vários clientes, e o esforço do atual mercado imobiliário foi chegou a eles. Este tinha sido um dia frio incomum para o mês de Janeiro, com temperaturas oscilando ao redor 60° graus. Ao chegar em casa, decidiram relaxar na banheira de hidromassagem com alguns vinhos. Enquanto Roma mudou sua roupa de trabalho, Clint disse que iria acompanhá-la na banheira de água quente, depois ele tomou o seu Lasix . Sábado, Oito da manhã … Por favor, indique a sua emergência. "Oh , Oh, EU ... EU ... Acalme-se e me diga o endereço." "Eu acho que…, sim, OK, … Oak Creek Drive." "Qual é o problema, por favor?" "Eu sou a empregada dos Sr. e a Sra. Underhil le… e eu não estou encontrando-os em casa quando cheguei esta manhã, assim, olhei ao redor e na parte de fora. Eu acabei de encontrar na sua banheira de hidromassagem para fora da parte traseira. Eles estão debaixo da água. "Sim, estou alertando os emts e uma ambulância será no caminho. Por favor, vá em frente e aguardar, de modo que os paramédicos podem localizar o endereço rapidamente." Sábado, 8:10 da manhã Paramédicos Kavita Dickson e Larry Gonzales trouxe a ambulância para uma parada...
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...| |origin. | | |Alzheimer's Disease |Alzheimer's disease is a disorder in which|Not currently being treated | | |nerve cells (neurons) in the brain | | | |degenerate and eventually die (Mayo | | | |Clinic, 2010). | | |Edema |Edema is swelling caused by excess fluid |Lasix | | |trapped in the body's tissues (Mayo | | | |Clinic, 2010). |...
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...Clinical management and patient’s response and evidence based comparisons Upon admission, following subsequent blood works, the doctor on duty ordered for Miss N.M. to be administered IV Lasix 40mg, Nifedipine 10mg po stat, cocktail stat (100cc 50% Dextrose, 20 cc of calcium gluconate and 20 units of soluble insulin) slow push to be infused 3 unit of Packed Red Blood Cells, and IVF 2.5L/24 hrs: normal saline. Four days later Miss N.M. was diagnosed with Hypokalemia, obstructive Uropathy, Anaemia and Likely Cervical Cancer. A biopsy confirmed Cervical Cancer Stage III B and bilateral Nephrostomy tubes were ordered and inserted to aid the client in eliminating wastes from here body. With the administration of the IV Lasix 40 mg and Nifedipine 10 mg po there was a significant improvement in the client’s blood pressure readings 149/96 122/82. However, there was still no urinary output of significance. There should have been increased urinary output due to the therapeutic action of this loop diuretic. The administering of the loop diuretic, cocktail (100cc 50% Dextrose, 20 cc of calcium gluconate and 20 units of soluble insulin) and the insertion of the nephrostomy tubes improved the clients potassium reading from a 7.6 to a 5.8mEq/l. Normal potassium level range between 3.5-5.0. The potassium level in the blood was still elevated thus Kayexalate 15g po tds was added to the regime. This antihyperkalemic drug releases sodium ions in exchange primarily for potassium ions and ultimately...
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