Question

Sarah Smith, a 73-year-old white female with lung cancer, has been receiving chemotherapy on an outpatient basis. She completed her third treatment 5 days ago and has been experiencing nausea and vomiting for 2 days even though she has been using ondansetron (Zofran) orally as directed. Ms. Smith’s daughter brings her to the hospital, where she is admitted to the medical unit. The admitting nurse performs a thorough assessment.

Subjective Data: Complains of lethargy, weakness, dizziness, and a dry mouth. States she has been too nauseated to eat or drink anything for 2 days

Objective Data: Heart rate 110 beats/min, pulse thread, blood pressure 100/65: weight loss of 5 pounds since she received her chemotherapy treatment 5 days ago: dry oral mucous membranes

1. Based on her clinical manifestations, what fluid imbalance does Ms. Smith have?

2. What additional assessment data should the nurse obtain?

3. What are the patient’s risk factors for fluid and electrolyte imbalances?

4. The nurse draws blood for a serum chemistry evaluation. What electrolyte imbalances are likely and why?

5. The physician orders dextrose 5% in 0.45% saline to infuse at 100 ml/hr. What type of solution is this and how will it help Ms. Smith’s fluid imbalance?

6. What are the priority nursing interventions for Mrs. Smith?

7. Because of the nature of her disease process, Ms. Smith is at risk for the development of SIADH. How would the nurse recognize this complication and what is the anticipated treatment?

Answer 1

A) HYPOVOLEMIA
B) CHECK FOR :
ORTHOSTATIC HYPOTENSION
RESPIRATORY RATE,
LEVEL OF CONSCIOUSNESS,
PUPILS,
VOLUNTARY MOVEMENT,
CAPILLARY REFILL,
SKIN TURGOR,
TEMPERATURE,
EDEMA, AND FEEL TEMPERATURE OF SKIN

C) NAUSEA, VOMITING, NOT DRINKING FLUIDS, AND OLDER AGE.

D) Na+ ,K+ ,Cl- ARE THE MAIN ELECTROLYTE WHICH SHOWS IMBALANCE DUE TO LONG DEHYDRATED CONDITION.

E)HYPERTONIC : IT WILL RAISE THE OSMOLALITY OF THE ECF AND THEN THE FREE WATER WILL EXPAND THE ECF AND ICF.

F) CHECK FOR :
INTAKE & OUTPUT
MONITOR CARDIAC CHANGES ,
RESPIRATORY STATUS,
SKIN ASSESSMENT,  
DAILY WEIGHTS.

G)
BLOOD AND URINE TEST.
THE NURSE WILL RECOGNIZE THE MEDICAL CONDITION THAT IT IS ELECTROLYTE IMBALANCE SUCH AS Na+.
PATIENT WILL HAVE IMPAIRED JUDGEMENT, STUPOR, SEIZURES and IRRITABILITY.
THE TREATMENT WILL INCLUDE :
FLUID AND WATER INTAKE RESTRICTION, ADMINISTER VASOPRESSIN
OR
EVEN A SURGICAL OPERATION TO REMOVE THE TUMOR PRODUCING ADH HORMONE.