Question

PN 200 Fundamentals of Nursing II Concept Map: Hypovolemia/ Deficient Fluid Volume Charles West, a 70 y/o man was brought to the Emergency Department at 4:30 AM by his wife. She told the emergency room triage nurse that he has a lot of "dark red" diarrhea for the past 3 days and last night. When he became very dizzy, disoriented and weak this morning, she decided to bring him to the hospital. Mr. West's vital signs were B/P 70/- (diastolic blood pressure inaudible) Pulse 110 weak and easily obliterated, and respirations 24. A 16-gauge IV catheter was inserted and Lactated Ringer's infusion at 125 m/L per hour was started. .Two years ago he experienced a cardiac arrest that was attributed to hypokalemia. He also has a long history of hypertension and arthritis. Fifteen years ago, he was diagnosed with a peptic ulcer. An endoscopy showed a 25mmX15mm duodenal ulcer with adherent clot. The ulcer was cauterized and Mr. West was admitted to the Medical intensive care unit for treatment of his volume deficit. You are the admitting nurse. As you are making him comfortable, Mrs. West gives you a paper bag filled with the bottles of the medications Mr. West has been taking. Vasotec 5mgm po bid Coumadin Smgm po qd Digoxin 0.125 mg po qd KCL 20 mEq po bid Tolimentin 400mgm po tid (non-steroid NSAID) Doing a quick assessment, you find a pale man who is sleepy but arousable and oriented. He is still dizzy, hypertensive and tachycardia. You hear S 3 and S 4 heart sounds. Peripheral pulses are present and trace pedal edema is present. Lung sounds are clear. Bowel sounds are present, gastric tenderness is noted and the liver margin is 4cm below the costal margin. Mr. West receives a total of 4 units of PRBC's, 5 units of FFP (fresh frozen plasma) and many units of crystalloid solution to keep his systolic B/P above 90mmHg. As soon as you get a chance, you look at Mr. West's' admission lab results: 6.2 90mg/dl 2.1 K. BUN Creatinine Hgb Het 8.4 25% 16,000 WBC PT 23.4 4.2 INR 1/20.

Answer 1

The patients signs and symptoms confirms he is in hypovolemia. Due to blood in diarrhea the hemoglobin in the blood as decreased and is required for transfusion of packed red blood cells. In order to increase his plasma volume the FFP, crystalloid solution has been administered .This as a result will increase the blood pressure

The renal system has been altered because of this causing the creatinine and the blood urea nitrogen to be increased. The increased level of WBC shows the patient is being infected. The increased level of PT INR indicates that the clotting mechanism is slow and putting the patient at risk for bleeding. The increased potassium level will lead to alteration in the cardiac functions.

The liver should be normal 1cm below the coastal margin but here it is 4cm ,this indicates a liver problem

The use of coumadin has increased the level of PT INR values

The use of KCL with diarrhea has contributed to increased potassium level. This level will generally cause disoriention and cardiac issues.

The use of Tolmentin can lead to gastric erosion due to ulceration and increase the risk of bleeding

The risk for digoxin toxicity is possible which can lead to hyperkalemia.

This patient needs fluid correction, potassium correction, monitoring renal function, increasing the hemoglobin levels and treating any infection