1/3
Stop & Think
Your patient with ACUTE HEART FAILURE received IV furosemide.
2 HOURS LATER...
- 🫁 Crackles improved
- ⚖️ Weight ↓ 1 lb
- ❤️ BP 88/54
- 😵 Reports dizziness
What should the nurse do NEXT?
2/3
Your Turn
Which response is BEST?
If you chose A...
✕ Not quite.
Why?
✓The crackles improved. That's good.
!But... the patient's condition changed.
🪥 NEW cues:
- • BP 88/54
- • Reports dizziness
!These findings suggest decreased tissue perfusion.
⚠Giving another dose of furosemide could make the hypotension worse.
💡 CJMM PEARL
Don't chase the original problem. Respond to the
NEW priority.
Curious about the other choices?
If you chose B...
! Partly right.
Why?
✓You recognized improvement.
!But you stopped evaluating too soon.
🔍 Clinical judgment evaluates ALL outcomes.
Monitoring is important, but it's not the BEST next action.
Curious about the other choices?
If you chose C...
✓ Excellent choice!
Why?
🫁Lasix reduced preload and improved congestion.
❤However, excessive volume loss can reduce cardiac output and BP.
👤The patient's priority CHANGED.
⭐ You responded to the NEW priority.
Curious about the other choices?
If you chose D...
⚠ Low BP... give fluids?
Why?
✓It sounds logical.
!Except...
💉 Heart failure patients cannot safely receive fluids without understanding WHY they're hypotensive.
💡 CJMM PEARL
Treating the number without understanding the physiology may worsen heart failure.
Curious about the other choices?
3/3
CJMM Debrief
This question wasn't really about Lasix. It was about recognizing that the patient's PRIORITY CHANGED.
🔍
Recognize cues
What's going on?
🧠
Analyze cues
What do they mean?
📋
Prioritize hypotheses
What's the priority?
🏃
Generate solutions
What can we do?
✓
Take action
Do the right thing.
📈
Evaluate outcomes
Did it help?
🎯 THE TAKEAWAY
Great nurses don't just follow the plan.
They reassess, recognize change, and respond to what matters MOST.
🧠 @TheCJMMCoach