Reflection Analysis In Nursing

Introduction This reflection analysis in my clinical practice includes Mr. Blank, myself as the student nurse, Julie the primary nurse for Mr. Blank, and the clinical instructor. The names of the patient and primary nurse will be fictional throughout this analysis to preserve confidentiality. Mr. Blank had altered heart function, Diabetes with poor kidney function, Hodgkin’s Lymphoma, and other health issues. He was admitted to the cardiac floor, and aside from his diagnosis, he had pneumonia and had been at the hospital for a little over a week. The day prior to my clinical day, Mr. Blank had undergone a thoracentesis due to the heavy accumulation of fluid in his body as evidenced by his peripheral edema, which was not responding to any other …show more content…
Blank’s medications, but other than that there were no major barriers to his discharge. I took the newly acquired information and went to research my patient some more in regards to how he was doing at the hospital, his recent blood work and other pertinent information that I felt would help me understand him more on a clinical level. I noted that his sodium levels were low and they had been somewhat low the last couple days so I took this information to Julie and she asked me to go and let the doctor know of this. When I informed the resident doctor of this information, he stated that he was not worried of the sodium lab value, and that he was going to write an order for a STAT dose of Lasix, and a fluid restriction of 1.5L. I walked back to the nursing station confused as I was unsure why this doctor wanted to place my patient with a low sodium level, altered kidney function, and low blood pressure, on a STAT dose of Lasix when he was already receiving Lasix BID via IV. I let my primary nurse Julie know of this, and she too, was somewhat confused. Julie went to clarify the order, which indeed was to be given, and she administered it. I took my concerns and questions then to my clinical instructor who also felt that this was an unusual situation and wanted to find out for herself as to what …show more content…
Blank given a STAT dose of Lasix via IV to “dry out” his lungs, considering his altered kidney function, low sodium level, low blood pressure, and removal of two liters of fluid from his body the day before. My concerns were the potential for electrolyte imbalances, as well as other negative effects. According to the literature, due to the efficacy of loop diuretics, electrolyte imbalances such as hyponatremia, hypokalemia, hyperuricemia, hypercalcemia and hypocalcemia can occur with diuretic use in people with chronic kidney disease (Sica, 2014). However, utilizing my previous nursing knowledge, the dosage of diuretics is dependent on many factors, but as mainly the kidney glomerular filtration rate of the person in which the diuretic would be administered to. When a patient has chronic kidney disease, it is understood that the glomerular filtration rate is decreased, and in turn, it would make sense that “in patients with advanced CKD, an increased diuretic dose must be given to ensure delivery of tubular fluid sufficient to elicit a diuretic response (Sica, 2014)”. Given the consideration that Mr. Blank has chronic kidney disease because of his diabetes, it would make sense that the dosage of Lasix would have to be higher so that a more therapeutic effect could be reached in terms of reducing the congestion from Mr. Blank’s

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