Which of the following adverse reactions is found more often in volume-depleted elderly clients?
A. Bradycardia
B. Conduction defects
C. Ankle edema
D. Hypotension
Correct Answer: D. Hypotension
Hypotension is more likely to occur in the elderly. Vital signs can be a key assessment in volume status. The kidneys have an autoregulation system, which allows renal blood flow to remain stable between systolic blood pressures of 80 mm Hg to 180 mm Hg. Hypotension, when blood pressure falls below 80 mm Hg, can diminish renal perfusion and could potentially precipitate renal failure. Othr adverse reactions may occur but are not necessarily increased in frequency in elderly clients.
Option A: Vital signs can be a key assessment in volume status. Postural hypotension, leading to dizziness may be indicative of hypovolemia. Tachycardia can be seen with volume depletion, as can orthostatic blood pressure readings. Again, both can be nonspecific for hypovolemia, but orthostatic hypotension will be found with profound hypo-volemia.
Option B: Other medications may require serum monitoring. These medications include antibiotics and antiarrhythmics. As GFR decreases, so does the clearance of renally excreted medication. This is especially important in the old-old where GFR has decreased by 30% to 50% by 80 years of age. Cardiac drugs include digoxin and procainamide.
Option C: The most significant sign of volume depletion is acute weight loss, which is defined as a 3% or greater loss in body weight. Numerous factors can affect the accuracy of daily weights, but a running trend may provide the first indication of volume status.