Question

The next patient is a 67 year old female, Helen Webb, who presents with a chief complaint: “I can’t sleep at night---I can’t lie down, I get so out of breath.” She is sitting in high Fowler’s position on the exam table. She has a history of heart problems. She is diagnosed with acute exacerbation of congestive heart failure, and you identify a nursing diagnosis of Fluid Volume Excess (FVE). 1. What is the term you should use to document the patient’s chief complaint regarding her breathing? _____________________________ 2. Besides the respiratory difficulty the patient is describing, what other manifestations of FVE may be present on assessment? The physician gives you the following orders: (Consult your drug guide if necessary). • D5LR at 100mL/hr (you will be using an infusion pump) • Furosemide (Lasix) 80 mg IV now • Potassium citrate (K-lyte) 10 mEq orally now and every 4 hours X 2 doses • O2 2-4 LPM via nasal cannula to keep 02 sat greater than 92% 3. Which order should the nurse question? Why 4. Over the course of 8 hours the patient has a weight loss of 11 pounds. This represents how much fluid loss? 2.2 lb = 1000 mL of fluid? The patient was admitted and after 2 days is ready for discharge. Discharge orders include a low-sodium (2000 mg/day) diet and a fluid restriction of 1500 mL/day. 5. Describe the key information that the patient needs to know to follow these instructions. (Include foods to limit and foods to include/strategies related to the fluid restriction).

Answer 1

1. Cheyne stokes respiration

2. Excess weight gain

3.The nurse will question D5LR Administration order.

As the intravenous administration of Lactated Ringer's and 5% Dextrose Injection, USP can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema. The risk of dilutional states is inversely proportional to the electrolyte concentrations of the injection. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of the injection.

4. 2.2 lb = 1000mL of fluid

As, 11/2.2= 5

This implies (2.2*5)lb = (1000*5)mL

Hence 11lb =5000mL of fluid loss.

5.The following foods are high in sodium and should be avoided on a low-sodium diet:

• Fast food: Burgers, fries, chicken fingers, pizza, etc.
• Salty snack foods: Salted pretzels, chips, salted nuts, salted crackers, etc.
• Frozen dinners: Frozen meat dishes, frozen pizza, etc.
• Processed meats: Bacon, sausage, lunch meats and hot dogs.
• Salted, canned products: Vegetables, pastas, meats, fish, etc.
• Salty soups: Canned soups and packaged soups.
• Cheese and dairy: Cheese, cheese spreads, cottage cheese, buttermilk, salted butter and cheese sauce.
• High-sodium baked goods: Salted rolls, salted bagels, croutons and crackers.
• Baking mixes: High-sodium waffle, pancake or cake mixes.
• Boxed meals: Macaroni and cheese, pasta meals, rice meals, etc.
• High-sodium side dishes: Stuffing, boxed au gratin potatoes, hash browns and rice pilaf.
• Sauces and condiments: Gravy, soy sauce, commercial tomato sauce, salsa and salad dressing.
• Pickled vegetables: Pickles, olives and sauerkraut.
• Certain drinks: Regular vegetable juice, juice blends and salty alcoholic beverages.
• Seasonings: Salt and salt blends

The following foods are low in sodium and safe to eat on a low-sodium diet:

• Fresh and frozen vegetables (without sauces): Greens, broccoli, cauliflower, peppers, etc.
• Fresh, frozen or dried fruits: Berries, apples, bananas, pears, etc.
• Grains and beans: Dried beans, brown rice, farro, quinoa and whole wheat pasta.
• Starchy vegetables: Potatoes, sweet potatoes, butternut squash and parsnips.
• Fresh or frozen meat and poultry: Chicken, turkey, beef or pork.
• Fresh or frozen fish: Cod, sea bass, tuna, etc.
• Eggs: Whole eggs and egg whites.
• Healthy fats: Olive oil, avocado and avocado oil.
• Low-sodium soups: Low-sodium canned or homemade soups.
• Dairy products: Milk, yogurt, unsalted butter and low-sodium cheeses.
• Bread and baked goods: Whole-wheat bread, low-sodium tortillas and unsalted crackers.
• Unsalted nuts and seeds: Pumpkin seeds, almonds, peanuts, etc.
• Low-sodium snack foods: Unsalted pretzels, unsalted popcorn and unsalted tortilla chips.
• Low-sodium condiments: Vinegar, mayonnaise, low-sodium salad dressing and low-sodium sauces.
• Low-sodium beverages: Tea, coffee, low-sodium vegetable juice and water.
• Low-sodium seasonings: Garlic powder, no-salt blends, herbs and spices.

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