N.H., an 89-year-old widow, recently experienced a left-sided cerebrovascular accident (CVA). She has

Question

right-sided weakness and expressive aphasia with minimal swallowing difficulty.

N.H. has a past medical
history of a minor left-sided CVA 2 ½ years ago, chronic atrial flutter, and hypertension. She has lived with
her daughter's family in a rural town since her previous stroke. Since admission to an acute care facility
5 days ago, N.H. has gained some strength, has become oriented to person and place, and is anxious to
begin her rehabilitation program. She is transferred for rehabilitation to your skilled nursing facility with
the orders shown in the chart.
What laboratory orders would you anticipate as a result of this specific list of orders? With
each response, describe your rationale.

Answer 1

• Chemistry studies to monitor the sodium, potassium, chloride, and carbon dioxide.
Hydrochlorothiazide can affect potassium, sodium, chloride, glucose, BUN, and creatinine.
• PT/INR to monitor the anticoagulant effects of the warfarin.
• Digoxin level should be kept within therapeutic range (0.5 to 2.0 ng/mL) to prevent cardiovascular
side effects such as dysrhythmias and bradycardia. Keep in mind that toxicity can also occur within
the therapeutic range. In addition, hypokalemia (from the hydrochlorothiazide therapy) might
lead to digoxin toxicity.