QLexNursing

🔷 Client verbal report (diarrhea, dry mouth, unusual thirst × 3 days)

📌Why to hold: These symptoms indicate volume depletion/dehydration. Giving a loop diuretic (furosemide) now can precipitate hypotension, prerenal azotemia/AKI, electrolyte losses, and dizziness/syncope.

📌What to do: Hold furosemide and notify the provider. Assess orthostatic vitals, mucous membranes, weight trends, and urine output. Consider IV/oral fluid replacement per orders and recheck basic metabolic panel.

📌Safety focus: Dehydration + loop diuretic = high risk of hemodynamic instability and renal hypoperfusion.

🔷 Potassium level (3.2 mEq/L) — hypokalemia

📌Why to hold: Furosemide promotes renal K⁺ wasting, which would worsen hypokalemia (already 3.2). Hypokalemia raises risk for ventricular dysrhythmias, muscle weakness, and digoxin toxicity.

📌What to do: Hold furosemide and obtain orders for potassium repletion (PO/IV per protocol), ECG monitoring (look for flattened T waves, U waves), and repeat labs after repletion.

📌Longer-term: Consider adding a K⁺-sparing agent (e.g., spironolactone) or increasing scheduled KCl if appropriate for HF plan.

🔷 Prescription for digoxin (0.125 mg daily)

📌Why to hold: Digoxin toxicity risk increases markedly in hypokalemia because low K⁺ enhances digoxin binding to Na⁺/K⁺-ATPase. Starting/continuing a loop diuretic in a patient on digoxin with K⁺ 3.2 can trigger arrhythmias, nausea, visual changes, and brady/tachydysrhythmias.

📌What to do: Hold furosemide, correct K⁺ first, consider checking a digoxin level and renal function, and monitor rhythm. Coordinate with the provider on sequencing meds (e.g., replete K⁺ → reassess → resume diuretic).