nurn 110 nursing process focus patients receiving hydrochlorothiazide
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NURN 110 Nursing Process Focus: Patients Receiving
Hydrochlorothiazide
Assessment Potential Nursing Diagnoses
Prior to administration: • Fluid volume excess, related to
• Obtain complete health history early stages of drug therapy
including allergies; cardiac, • Fluid volume, Risk for deficient,
pulmonary, renal, and biliary related
disorders including blood studies: to excessive drug effect
CBC, BUN, creatinine, electrolytes, PT, • Urinary elimination, Impaired
PTT, liver enzymes, etc. related to frequent urinary
• Obtain patient’s drug history to output
• Fatigue, related to excessive fluid
determine possible drug loss
interactions and allergies • Health maintenance, Ineffective
• Obtain vital signs, including blood
pressure related to disease process
• Auscultate chest sounds for
crackles indicative of
pulmonary edema.
• Assess lower limbs for edema; note
character/level (e.g. "++ pitting")
Planning: Patient Goals and Expected Outcomes
The patient will:
• Exhibit a reduction in systolic/diastolic blood pressure.
• Demonstrate electrolyte levels within normal limits during drug therapy.
• Demonstrate understanding of the drug's action by accurately describing drug
side effects and precautions.
• Demonstrate urinary output within normal levels
Implementation
Interventions and (Rationales) Patient Education/Discharge Planning
• Monitor vital signs, especially blood Instruct the patient to:
pressure. (Diuretics reduce • Monitor vital signs daily (or as
circulating blood volume, resulting in specified by the health care
lowered blood pressure.). provider), particularly blood
pressure, ensuring proper use of
home equipment.
• Withhold medication for severe
hypotensive
readings as specified by the health
care provider (e.g. "hold for levels
below 88/50").
• Observe for changes in level of Instruct the patient to
• Immediately report any change
, consciousness, dizziness, fatigue, in consciousness, especially
postural hypotension. (Reduction in feeling faint.
circulating blood volume may • Avoid abrupt changes in posture; rise
produce changes in level of slowly
consciousness or syncope.) • from prolonged periods of
sitting/lying down.
• Obtain blood pressure readings in
sitting,
standing and supine positions to
monitor fluctuations in blood
pressure.
• Monitor for fluid overload and signs Instruct the patient to:
of • Immediately report any severe
congestive heart failure, including shortness of
, electrolyte balance, intake and breath, frothy sputum, profound
output, and daily weights. fatigue and edema in extremities,
• (Increased blood volume causes potential signs of heart failure or
increased cardiac workload and pulmonary edema
pulmonary edema.) • Accurately measure intake,
output, body weight; measure
and weigh daily.
• Evaluate "insensible loss" occurring
from
sweat, etc; avoid excessive heat,
which contributes to increases in
insensible loss.
• Consume adequate amounts of plain
water
• Remain adequately but not over-
hydrated.
that increased urine output and
decreased weight indicate that the
drug is working.
• Monitor nutritional status. Instruct patients to:
(Electrolyte imbalances may be • Take medication with a glass of
counteracted by dietary measures.) orange juice to promote adequate
potassium intake.
• Use sparing amounts of "salt
substitute"
(potassium chloride) to season foods.
• Avoid excessive use (20 grams or
one half oz.) of natural black licorice
(licorice root), which can reduce
potassium levels.
• Consult with health care provider
before using unprescribed
vitamin/mineral supplements or
electrolyte-fortified sports
drinks.
• Use with caution in diabetics. • Provide patients with written
Observe for signs of hyperglycemia. materials on diabetes mellitus
(Hydrochlorothiazide alters glycemic signs, symptoms and treatment of
control diabetes mellitus
and may cause hyperglycemia.)
• Monitor renal and metabolic function Instruct the patient or caregiver to:
• Immediately report signs and
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