Question

The next patient to arrive is an 85 year old woman who was brought to the ED following three days of nausea, vomiting and diarrhea. 1. What electrolyte imbalances might the nurse expect to be present? What fluid imbalance is most likely present? 2. What are the nurse’s priority assessments to determine the presence of a fluid imbalance? 3. Given the patient’s symptoms, age, and the fluid imbalance that is likely present, what safety factors must the nurse consider when planning and delegating nursing care? 4. What acid/base imbalances might the nurse expect to be present and why? 5. Why are older adults particularly at risk for developing dehydration? 6. If IV fluids are ordered, what special precautions must be taken due to the patient’s age?

Answer 1

1 a Serum electrolyte changes may also occur.Potassium and sodium levels can be reduced or elevated.

• Hypokalemia can occur with GI and renal losses.
• Hyperkalemia occurs with adrenal insufficiency
• Hyponatremia occurs with increased thirst and ADH release.
• Hypernatremia results from increased insensible losses and diabetes insipidus.

b Fluid volume deficit (FVD)or hypovolemia is most likely to be present .it occurs when loss of ECF volume exceeds the fluid intake.causes of FVD include abnormal fluid losses ,such as those resulting from vomiting,diarrhoes,GI suctioning,sweating and decreased intake ,as in nausea.

2

• Laboratory data which includes BUN and its relation to serum cratinine concentrationis useful in evaluating fluid volume status.
• The cause of hypovolemia can be determined through health history and physical examination.
• Urine specific gravity will also be increased.
• Assessment of Intake and output atleast every 8 hours.
• Skin and tongue turgor is monitored on a regular basis.

3 Elderly patients have special nursing care needs because of their propensity for developing fluid and electrolyte imbalances.Fluid balance in many elderly patients is often marginal at best because of certain physiologic changes assoiated with ageing process.Some of these changes include reduction in total body water,renal function,cardiovascula,respiratory function,Although these changes are often viewed as a normal part of the ageing process,they must be considered when elderly people become ill,because age-related changes predispose people to fluid and electrolyte imbalances.These physiologic changes must be considered during assessment of elderly patients.Assessment of elderly patients should be modified somewhat from that of younger adults.In elderly patients skin turgor is best tested over the forehead or the sternum,because alterations in skin elasticity are less marked in these areas.The nurse should perform a functional assessment of the ability of the elderly patient to determine fluid and food needs and to obtain adequate intake.

4 Identification of the specific acid-base imbalance is important in identifying the underlying cause of the disease and determining appropriate treatment.Acute and chronic metabolic Acidosis is expected in this condition .Because the most common cause of metabolic acidosis is vomiting and nausea.

5The main reason is that elderly patients deliberately restrict the fluid intake to avoid embarassing episodes of icontinence.Elderly patients without cardiovascular or renal dysfunction should be reminded to drink adequate fluids ,particularly in very warm or humid climate.

6 Fluids should be administered at specific rates and intervals while the patients haemodynamic status is monitored.Fluid challenge test should be done, the goal of the test is to provide fluids rapidly enough to attain tissue perfusion without compromising the cardiovascular system.Accurate and frequrent assessments of intake and output ,weight,vital signs,CVP,breath sounds and skin colour should be performed to determine when therapy should be slowed to avoid fluid overload.