Pediatric Exam Question Regarding Lasix and Furosemide

[leahashleigh123]

For the following question, my classmates and I have established contradicting answers and I'm wondering if I can get some input regarding the answer choices.

I will explain my rationale in hopes that someone can explain why it would be correct or incorrect.

The nurse is caring for a child with VSD who is receiving Lasix and Digoxin. Which of the following nursing diagnosis is appropriate due to the medications the child is on?

a. Fluid volume overload

b. Potential electrolyte imbalance

c. Potential for imbalanced nutrition

d. Ineffective breathing pattern

I would go with B. only because due to the medications (specifically Lasix) they are at risk of fluid volume deficit but loss of potassium because it is non-potassium sparing. Also, digoxin toxicity risk increases if the patient is hypokalemic so electrolyte monitoring is HUGE. The key for me here was that the professor highlighted DUE TO the medications. I would be interested in any input! Thank you

[Here.I.Stand, BSN, RN]

Which of the following nursing diagnosis is appropriate due to the medications the child is on?[/Quote]

I would choose B. The child is at risk for all four answers; however the other risks are due to the VSD -- not the meds.

A left-to-right shunt results in excess fluid through the pulmonary artery, pulmonary edema develops which creates an ineffective breathing pattern, and the ensuing fatigue can cause feeding difficulties leading to imbalanced nutrition.

[Here.I.Stand, BSN, RN]

Im not super familiar with VSD's but if you have too much fluid overloading your lungs, you might either have pulmonary hypertension or maybe even pulmonary edema. Neither of these would cause an ineffective breathing PATTERN. [/Quote]

My 13 yr old son had a VSD; the first sign of CHF was tachypnea -- particularly when feeding. He was put on Lasix at 3 weeks old, and then started digoxin a week later. The thing that said the Lasix was insufficient: he now was tachypneic AND having retractions.

They never checked an ABG, but his O2 sats were always in the high 90s.

So definitely an altered breathing pattern, and to our knowledge no gas exchange issues.

Edited to add: his experience wasn't anecdotal; his cardiologist and my postpartum nurses all advised me to watch and call for rapid/labored breathing.

[AnnieOaklyRN, BSN, RN, EMT-P]

It would be B, because it says risk DUE TO THE MEDICATION, which would be electrolyte imbalance secondary to the Lasix. He may be at risk for malnutrition, but that isn't caused by the medication that would be caused by the disease process. Same with fluid overload, that is caused by the disease, the medications are meant to help with it. Finally the child is at risk for breathing difficulty, but again this is due to the disease process.

Annie