A patient with 3+ peripheral edema, V/S = P–112, BP–162/100, R–32, T–98.9 and a low GFR is receiving hydrochlorothiazide (HydroDIURIL). The most effective nursing action would be to
a. administer hydrochlorothiazide as ordered.
b. request furosemide (Lasix).
c. request spironolactone (Aldactone).
d. hydrate the patient to improve the GFR.
B
Furosemide can promote fluid loss even when the GFR is low, whereas the thiazide diuretics are not effective with renal dysfunction. Loop diuretics, such as hydrochlorothiazide, are also pre-ferred to thiazides when cardiac output is greatly reduced. This patient is displaying serious fluid overload and needs effective diuresis.
The nurse should not continue the hydrochlorothiazide, because it will not be effective with this patient, who has a low GFR.
Spironolactone (Aldactone) will not be as effective as a loop diuretic, and nothing indicates that the patient has a low potassium level.
Hydrating the patient would only worsen the fluid overload.
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