Question

Please remember to include APA citations for your information where appropriate.

List common causes of fluid volume deficit and fluid volume overload. In a chart format, provide the assessment findings that constitute a patient with Fluid deficit (hypovolemia) vs. Fluid overload (hypervolemia).

Meet the Client: Patty Mills

Patty Mills is a 74-year-old female with a past medical history of coronary artery disease with stent placement, hypertension, and diabetes. Her son brought her to the Emergency Department because she has become increasingly weak and confused and was found by a neighbor wandering her neighborhood unable to locate her home. Patty’s son tells the nurse that his mother takes a "water pill" for her blood pressure 2 or 3 times a day. The label on the medication bottle that she brought to the hospital states, “Furosemide 40mg BID". Patty is admitted with fluid volume deficit.

1. What health challenges does your patient face? (Please give more than one). - (This is not a list of their symptoms, but critical elements that will cause/place the pt. a risk for a global problem, ex; pt. is immobile, NPO, and incontinent – one of the global issue here is r/t skin )
2. What on-going assessments and monitoring does your patient require related to their health challenges? (ie both inpatient and outpatient)
3. What education does your patient need at this time? (This could be new medications, new procedures, new way of living? Think about what the pt. will need once they are discharged as well) How do you plan to effectively provide this education?
4. What is your patient’s primary (priority) nursing diagnosis? (must place all three components of a nursing diagnosis for full points)
   a. Why does this take priority?
5. What nursing actions will you take in providing care to your patient? (Please think about the patient holistically. This should be a fairly comprehensive list. Include all necessary interventions related to the primary diagnosis, must be measurable and specific)

Answer 1

Causes of fluid volume deficit are:

- vomiting, diarrhoea, excessive sweating, burns, use of diuretics, kidney failure.

Causes of fluid volume overload:

- Heartfailure, liver cirrhosis, money failure, nephrotic syndrome, premenstrual edema, pregnancy. ( James L. Lewis, III ,MD Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham

HYPOVOLEMIA. Vs. HYPERVOLEMIA

* Tachycardia. * Weight gain

* Postural dizziness * edema

* Delayed capillary refill. * Shortness of breath

*Hypotension. * Hypertension

* Poor skin turgor. * Cramping, head ache and stomach bloating

Health challenges that Mrs. Patty can have are the following:

- Hypovolemic shock

- Dehydration

- poor skin integrity

- Anemia

- heart failure

- Brain and kidney damage

- impaired tissue perfusion

Assessment and monitoring needed includes the following:

- Assess the vital signs like heart rate, blood pressure, respiratory rate

- Assess for any signs of shock

- Assess for any signs of poor tissue perfusion like cyanosis

- Monitor the intake and output of the patient

- Monitor for any signs of dehydration like poor skin turgor

- Monitor the blood values to rule out any electrolyte imbalance

On outpatient basis:

- Monitor whether the patient is following a strict medication regimen as adviced

- Monitor the blood tests frequently to identify any abnormalities.

Patient education includes:

* Advice the patient and relatives to follo the strict medication regimen as adviced.

* Advice the patient to do regular check up and follow up

*Educate the patient to take the medicines as adviced by the physician

* Advice her to take plenty of oral fluids and keep her hydrated

* Advice her not to got out alone from home

* Teach her the symptoms and complications of Hypovolemia

* Advice her to live a healthy lifestyle

Inorder to effectively provide this education, first of all explain to her in simple terms. Teach her the importance of following the strict medication regimen and the complications that can arise if she doesn't follow the physician's advice. Teaching can be given in the form of drawings, roleplay or writing down the needed points in chart. So that it can be interesting and seek the attention of the patient.

Priority nursing diagnosis is:

Fluid and electrolyte imbalance related to loss of fluid from body secondary to improper intake of diuretics.

This is taken as priority because fluid loss from body can lead to impaired tissue perfusion and can cause brain damage,kidney failure and failure. Also, electrolyte imbalance and fluid loss may lead to shock and can be life threatening.

Nursing action include:

- Fluid replacement therapy by administering IV fluids

- Monitor vital signs and monitor for any signs of shock

- Monitor the intake and output of the patient

- Administer oxygen because poor perfusion affects the oxygen transport to the brain tissue

- Advice the patient to take plenty of fluids once awake

- Administer oral rehydration salt therapy to prevent dehydration if the patient is awake and oriented

- Monitor the blood test to identify any electrolyte imbalance and do the necessary electrolyte replacement as needed.