A client hospitalized for heart failure exacerbation has been receiving 40 mg furosemide IV twice daily. What statement by the client would alert the nurse to a possible toxic effect of this medication?
A.
This IV site seems irritated. It’s red and painful.
B.
I feel like I’ve done nothing but urinate since I’ve been here.
C.
Everything has started sounding muffled, I’m having difficulty hearing.
D.
My stomach is distended, and I haven’t had a bowel movement in 3 days.
The correct answer and Explanation is :
The correct answer is:
C. Everything has started sounding muffled, I’m having difficulty hearing.
Explanation:
Furosemide is a potent loop diuretic used to manage heart failure by promoting the excretion of sodium and water, thereby reducing fluid overload. While effective in treating symptoms of heart failure, furosemide can also lead to several adverse effects, including electrolyte imbalances and dehydration.
The statement about having difficulty hearing and everything sounding muffled is particularly concerning as it may indicate ototoxicity, which is a serious and potentially irreversible side effect of furosemide. Ototoxicity is characterized by damage to the ear structures responsible for hearing and balance. This can manifest as hearing loss, tinnitus (ringing in the ears), or a sensation of muffled hearing. This side effect is more common when high doses of furosemide are administered or if the medication is given rapidly via IV.
In contrast:
- A. This IV site seems irritated. It’s red and painful. This statement suggests a potential issue with the IV site itself, such as local infection or phlebitis, but it is not a direct indication of systemic toxicity related to furosemide.
- B. I feel like I’ve done nothing but urinate since I’ve been here. Frequent urination is a common effect of diuretics like furosemide, and while it can be bothersome, it is not indicative of toxic effects. However, it is essential to monitor for signs of dehydration and electrolyte imbalances.
- D. My stomach is distended, and I haven’t had a bowel movement in 3 days. This could suggest gastrointestinal issues, potentially related to dehydration or electrolyte imbalances, but it is less specific to furosemide toxicity compared to ototoxicity.
Regular monitoring of electrolyte levels and renal function is crucial in patients receiving furosemide to prevent and manage potential side effects. If ototoxicity is suspected, the dose of furosemide should be reviewed and potentially adjusted, and further audiological evaluation might be warranted.