A nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification?
A.
Laboratory testing of serum potassium upon admission
B.
Bumetanide 1 mg IV bolus every 12 hr
C.
0.9% normal saline IV at 50 mL/hr continuous
D.
Morphine sulfate 2 mg IV bolus every 2 hr PRN pain
The Correct answer and Explanation is:
The prescription that requires clarification is:
C. 0.9% normal saline IV at 50 mL/hr continuous
Explanation:
In the context of acute heart failure following a myocardial infarction (MI), fluid management is a critical aspect of treatment. Acute heart failure often involves volume overload due to the heart’s reduced ability to pump effectively. Proper management aims to reduce fluid overload and prevent further complications.
- Laboratory Testing of Serum Potassium Upon Admission (A): Monitoring serum potassium levels is essential in heart failure management. Diuretics used to manage heart failure can lead to hypokalemia or hyperkalemia, depending on the type of diuretic. Serum potassium levels help guide appropriate diuretic therapy and supplementation, making this prescription standard and appropriate.
- Bumetanide 1 mg IV Bolus Every 12 Hours (B): Bumetanide is a loop diuretic used to manage fluid overload by promoting diuresis. It helps decrease the heart’s volume load and reduces symptoms of congestion such as edema and pulmonary congestion. The dosage and frequency are typically adjusted based on the patient’s response and fluid status. This prescription is standard and appropriate for acute heart failure management.
- 0.9% Normal Saline IV at 50 mL/hr Continuous (C): Normal saline is an isotonic fluid, and while it can be used to restore blood volume, it is generally not preferred in acute heart failure patients unless there is a specific need for fluid resuscitation. In acute heart failure, especially after MI, the main concern is often fluid overload. Administering normal saline continuously could exacerbate fluid retention and worsening heart failure symptoms. Typically, fluid intake is carefully monitored and restricted, with preference for other strategies to manage fluid balance, such as diuretics, unless the patient is experiencing hypovolemia or dehydration.
- Morphine Sulfate 2 mg IV Bolus Every 2 Hours PRN Pain (D): Morphine sulfate can help alleviate pain and anxiety, reduce venous return (preload), and have a vasodilatory effect. It is often used in acute heart failure to help manage symptoms and improve comfort. This prescription is appropriate for managing pain and discomfort in this setting.
In summary, administering normal saline continuously to a patient with acute heart failure post-MI is potentially harmful and often requires clarification. Fluid management should focus on avoiding fluid overload and managing the heart’s capacity to handle fluid balance effectively.