Question

NAME: Class Learning Activity #2 NURSING 110: CONCEPTS & PRACTICE I CONCEPT MODELII: UNIT J: FLUID AND ELECTROLYTES Case Studies Fluid and Electrolyte Balance Case Study A 51-year-old African American female who was admitted to the hospital 24 hours ago with swollen legs and shortness of breath for 1 week. Weight gain 5 lbs in last 1 week. Patient states she has experienced this before since she was diagnosed with congestive heart failure last year. Patient is anxious and is unsure of what causes the swelling of her legs. She tells you that she has been eating a lot of salty foods lately PMH: HTN PSH: Rhip total hip replacement, cholecystectomy Social: lives in home with boyfriend and 2 daughters Medications: No Known drug or food allergies Lasix 80 mg once daily ASA 325 mg once daily Norvasc 5 mg once daily Physical Exam: Vital signs T 98.0 orally, P 64 (bounding). BP 160/84, R 24 at rest R36 when ambulating short distance Lungs: auscultation shows crackles bilaterally in bases Peripheral Vascular +2 pitting edema bilaterally from feet to mid-calf Lab diagnostics Hemoglobin 9 Hematocrit 28 Na 134 mEq/L K 3.2 mEq/L CI 96 mEq/L BUN 7 mg/dl Urine specific gravity 1.008 24-hour fluid Intake 240 ml decaf coffee 240 ml ginger ale 480 ml water 240 ml tea Output: 300ml am 350 ml afternoon (pm) 300 ml night (hs)

Answer 1

Case study A

subjective assessment: Complaint of shortness of breath for one week, patient is anxious, legs swelling

Objective assessment BP1 60/84, crackles on long auscultation, +2 pitting edema Bilaterally from feet to mid calf

labs:Low haemoglobin and haematocrit suggesting presence of anaemia.

Intake and output: patient has more intake than output suggesting fluid retention.

Risk factors: past medical history of congestive heart failure and hypertension, consumption of salty foods.

case study B

Subjective assessment: history of three day vomiting and diarrhoea

Subjective assessment: history of three day vomiting and diarrhoea

Feeling more sleepy than normal, no urination all day. Weight loss.

Objective assessment : pulse rate 124, low bp 72/44

skin turgor+tenting, sunken eyes, dry mucousa

Labs: High haematocrit due to fluid volume deficit

intake output: output is more than intake resulting in fluid deficit.

risk  factors:vomiting and diarhea

2. Case a is in fluid volume overload and case b in fluid volume deficit.

3. Lab values reflect fluid status as patient is at risk of developing high hematocrit, hypernatremia, hyperkalemia and increased urine specific gravity wheras low hematocrit , hyponatremia, hypokalemia and low specific gravity in fluid volume overload.

4.Nursing interventions for fluid overload:

• Instruct the patient To limit fluid intake
• Limit sodium intake
• Elevate Edematous legs And handle with care
• Administer diuretics as prescribed.

interventions for fluid volume deficit are:

• monitor and document vitals
• assess skin turgor and oral mucosa
• urge the patient to drink or liquid whatever she likes.
• provide comfortable environment by covering the patient with light sheets to avoid overheating.
• Find out the reason of vomiting and diarhea.
• administer required antiemetics or antidiarrheals as prescribed.

5.yes fluid can be administered to case study b patient as she is not able to take orally.isotonic fluid like Nacl 0.9% should be administered.