Case Study: 68-year-old Female on Furosemide, Digoxin and Hydralazine (Nursing)

00:00 Let's take a look at this next patient case. Mrs. Wright is a 68-year-old female patient with a history of congestive heart failure who is taking furosemide, digoxin, and hydralazine daily. She has developed an infection with <i>Staphylococcus aureus</i> and an urgent care physician would like to prescribe gentamicin. Okay. So let's back up and break this question down. Mrs. Wright is a 68-year-old female patient. I know that she has a history of congestive failure and she is taking furosemide, digoxin, and hydralazine. Okay, so what I know about congestive heart I'm worried about fluid volume overload. Furosemide, well that's a loop diuretic; digoxin, that's for congestive heart failure; and hydralazine, which is a vasodilator. She has developed an infection with <i>Staphylococcus aureus</i> and an urgent care physician wants to give gentamicin. Okay, so we 've got lots of medications in here. Furosemide, digoxin, and hydralazine and gentamicin. So those are the 4 medications. Now, if you're just taking this question with us first on video you can use your scratch paper to kind of help keep these in line. If you're taking it in the NCLEX eventually when you're sitting for your licensure exam, you can't write as many things but right now it's a really good strategy for you to underline those drug names, circle the diagnoses, you have them clear in your mind. Now, what is gentamicin? Right, it's an antibiotic and it's in the aminoglycoside family. Does there anything you remember about gentamicin, any adverse effects or any problems with gentamicin? As the nurse, should you follow up with a healthcare provider based on Mrs. Wright's diagnoses and/or medications. Well now we've got to go back and look at this.

01:51 Gentamicin - is that a problem with CHF? You have to decide yes or no. Gentamicin - is that a problem with furosemide? Yes or no. Gentamicin and digoxin and gentamicin and hydralazine.

02:07 That's the work it takes when you're breaking down these questions. So is there any problem with gentamicin in the diagnosis of CHF or the other medications? There actually is. Gentamicin is ototoxic. That means it's hard on the ears. You don't want to give 2 medications that have the same negative adverse effect. So since furosemide is possibly ototoxic, we don't want to give gentamicin which is also ototoxic because the patient could have a really bad result. So we want to be careful about that and contact the healthcare provider. Now they may decide to give the medication depending in if the furosemide is just a small oral dose, they'll make that consideration but the nurse's job is to recognize that this is a risk and contact the healthcare provider.