Question

Please help

S.S a 63 years old white women with acute lymphocytic leukerimina, has been receiving chemotherapy on an out patient basics. She complain her third treatment 5 days ago and has been experiencing nausea and vomiting for 2 days despite using ondansentron (Zofran) S.S’s daughter bring her to the hospital, where she is admitted to the medical unit. As the admitting nurse, you perform a thorough assessment

Subjective data

. Complain of lethargy, weakness, dizziness, and dry mouth

. States she has been too nauseated to eat or drink anything for 2 days

Objective data

. Heart rate 110 beats/min, pulse thready

. BP 100/65

. Weight lass of 5 lb since she received her chemotherapy treatment 5 days ago

. Dry oral mucous membranes

Question

1. Teamwork and Collaboration. What is the interprofessional team’s priority at this time for S.S?

2. The physical orders dextrose 5% in 0.45% saline to infuse at 100 mL/hr. What type of solution is this, and how will it help S.S’s fluid imbalance?

3. Priority Decision : What are the priority nursing interventions for S.S?

4. Evidence- Based Practice: S.S have a double-lumen PICC in her left arm. One lumen is connected to the IV infusion; the other is unused. What is the recommended practice for maintaining the patency of unused lumen?

5. Quality Improvement : what outcomes will indicate that interprofessional care was affective?

Expert Answer

Answer 1

1. Priority in the case patient with vomiting include

                       * Management of dehydraton due to vomiting.

                       * Correction of fluid and electrolyte imbalance.

2. * 5% Dextrose in 0.45% saline is a hypertonic solution.

    * Hypertonic solution contain high solute content and low solvent level which allow more fluid

      coming out from inside of body cells into blood circulation to maintain the fluid volume.

3. Priority nursing interventions for patient S.S.

               * Maintain the fluid and electrolyte level of the body through proper use of IV fluids as

                 per physicians order.

               * Continously monitor the intake and output of the patient.

               * Routine checking of electrolyte levels to identify imbalances of electrolytes in the body.

               * Assess the mental status and energy level of patient in each shift.

               * If the patient begin to control vomiting by antiemetics then give clear fluids orally to

                  maintain fluid volume.

4. For maintaining patency of unused lumen of PICC line flush it with 2 to 5 ml of normal saline(0.9%)

    once a day.

5. Indicators of affective outcomes of care in this patient include

            * Patient maintaining normal fluid and electrolyte level.

            * Able to follow a normal dietry pattern.

            * Vital signs become stable and no neurological problems.