Question

Fluid Electrolyte Acid-Base Critical Thinking Questions

Adapted from DeWit, S., Stromberg, H., & Dallred, C. (2017). Medical-surgical nursing (3^rd ed.). St. Louis, MO: Elsevier.

Scenario A:

              Mrs. Thompson, age 64, is admitted to the hospital for congestive heart failure. She is accompanied by her son. She is edematous in her legs to mid-thigh. Her neck veins are engorged when sitting upright. She is slightly confused on admission, and although she is not on absolute bed rest, she tells you she is too weak to get out of bed. She says she feels like she can’t breathe. Her son says she can’t afford her heart medications.

1. What assessments would you want to perform on Mrs. Thompson?

Blood pressure and heart rate respiratory rate, oxygen stations and dehydration

2. What labs or diagnostics tests might the provider order?
3. What type of diet would you expect the provider to order for Mrs. Thompson and why?
4. Why would daily weights be ordered for her?
5. What referrals may be needed for Mrs. Thompson?

Answer 1

1) What assessments would you want to perform on Mrs. Thompson?

Mrs.Thompson is admitted due to congestive heart failure and she says she feels like she can't breath ,as a health care provider to be assess her blood pressure ,heart rate and respiratory rate and also its important to assess her saturation level.

2 ) What labs or diagnostics tests might the provider order?

Mrs.Thompson admitted due to congestive heart failure ,while assessment noticed that her neck veins are engorged when sitting up right,She is edematous in her legs to mid-thigh and she complained that she feels like she can" breath , healthcare provider needs to order for chest xray and blood test for Arterial blood gas (ABG) ,renal profile and CBC cardiac markers such as Cardiac troponin,Creatinine kinase (CK) ,CK-MB and Myoglobin.

3) What type of diet would you expect the provider to order for Mrs. Thompson and why ?

Mrs.Thompson can take plenty of fruits and vegetables ,which are naturally low sodium and low potassium.Choose fresh foods including lean meats,fish,eggs low fat milk,and plain rice.When the person has heart failure ,heart does not pump out enough blood.This causes fluid build up in her body.....so she needs to restrict her water intake and sodium intake.

4) Why would daily weights be ordered for her?

Patient with congestive heart failure, heart is weakned because of this reason kidney may not get enough blood to work as well as they should.As a result ,body retains salt and water in a misguided attempt to boost blood volume .Checking daily weights is key to keeping an eye on symptoms.Weight gain is one of the first signs of retaining fluid.Congestive heart failure is the leading cause of fluid overload .