Question

A nurse is caring for a 65-year-old client with lung cancer who is receiving the second unit of a packed red blood cells transfusion. Assessment reveals dyspnea, tachycardia, neck vein distention, and rales on chest auscultation. The nurse expects to administer which of the following drugs? ? A. Dexamethasone (Decadron) ? B. Furosemide (Lasix) ? C. Propranolol (Inderal) ? D. Diphenhydramine (Benadryl)

Short answer

Answer: B. Furosemide (Lasix)

Step-by-step solution

Analyze symptoms

First, consider the symptoms that the client is experiencing: dyspnea (difficulty breathing), tachycardia (rapid heart rate), neck vein distention (swelling), and rales on chest auscultation (crackling sounds heard when listening to the lungs). These symptoms suggest the client may be experiencing fluid overload or an adverse transfusion reaction.

Investigate each medication

Next, we will look at each medication option and its uses: A. Dexamethasone (Decadron) - a corticosteroid used to reduce inflammation and suppress the immune system. It is possibly used to treat allergic transfusion reactions. However, it is not typically used for fluid overload. B. Furosemide (Lasix) - a diuretic used to help remove excess fluid from the body. It is often administered in cases of fluid overload and pulmonary edema. C. Propranolol (Inderal) - a beta-blocker used to lower high blood pressure, prevent angina (chest pain), and treat certain heart conditions. Not typically used to treat fluid overload or transfusion reactions. D. Diphenhydramine (Benadryl) - an antihistamine used to treat allergy symptoms. Can be used for mild transfusion reactions but not effective for fluid overload.

Select the appropriate medication

Given the client's symptoms and the medications' uses, the nurse is most likely to administer furosemide (Lasix) to address the fluid overload issue. Therefore, the correct answer is: ? B. Furosemide (Lasix)

Key concepts

Nursing Interventions

Nursing interventions are crucial actions taken by nurses to treat, minimize, or prevent various patient problems. They are often designed based on the specific needs of the patient and the symptoms they present. In this case, the patient is experiencing symptoms aligned with fluid overload, such as dyspnea and neck vein distention.
Nurses act swiftly to assess these symptoms and determine the best intervention. Key interventions can include monitoring vital signs, especially respiratory and cardiac status, to detect any worsening conditions. Accurate assessments help guide further medical decisions.
Nurses also ensure that patients are in a comfortable position, usually sitting up, to ease breathing. Clear communication with the healthcare team is vital, ensuring all members are informed of the patient's status and any interventions being performed. These actions, along with timely administration of medications, prepare the body for recovering homeostasis.

Transfusion Reactions

Transfusion reactions occur when the body responds negatively to blood or blood components received during a transfusion. This can range from mild allergic reactions to more severe, life-threatening conditions. Familiar symptoms include fever, chills, rash, and, in more severe cases, symptoms like dyspnea and cardiac distress.
Transfusion reactions require immediate attention, often necessitating the stop of the transfusion. Nurses must quickly identify the type of reaction and manage it appropriately. For example, antihistamines like diphenhydramine (Benadryl) can be used to treat mild allergic reactions. In contrast, more severe reactions require additional interventions and communication with the medical team.

Pharmacological Treatments

Pharmacological treatments are targeted approaches using medications to treat specific symptoms or conditions. In the context of this case, the primary concern is fluid overload, for which medication plays a pivotal role. Furosemide (Lasix) is a commonly used diuretic that effectively reduces fluid overload by increasing urine production, thereby helping to decrease fluid in the lungs and restore normal breathing.
Each medication option must be carefully considered against the symptoms presented. Nurses should have a comprehensive understanding of each drug's purpose, mechanism, and side effects. This ensures that the most effective treatment is provided and adverse effects are minimized. Advanced knowledge of pharmacology allows nurses to prepare patients adequately for any medication administered, offering insights into what to expect and potential responses.

Fluid Overload Management

Fluid overload management involves a combination of interventions, primarily focusing on methods to reduce and regulate the fluid in the body. This condition occurs when there is an excess of fluid, often related to medical treatments like intravenous therapy or blood transfusions. Symptoms such as dyspnea, neck vein distention, and lung crackles indicate the need for immediate management.
Managing fluid overload involves diuretics like furosemide to help the body expel excess fluid. It's crucial to monitor the patient's fluid intake and output carefully. Along with pharmacological interventions, adjusting dietary sodium intake and limiting fluid intake under the guidance of a healthcare provider are essential strategies.
By closely monitoring the patient's response to treatment, adjustments can be made to effectively manage and resolve fluid overload, ensuring better clinical outcomes and patient safety.