Question

1. Case Scenario #3

Case Scenario #3

You are a student nurse working on a medical unit. One of your assigned patients has a diagnosis of pneumonia. During shift change, you are told that the patient has had diarrhea for the last 4 days, accompanied by a 4-lb weight loss. She has been experiencing fever and chills, and she has had 150 mL of urine output during the last shift. The laboratory called with the following results: serum Na + 128 mEq/L, serum K + 4.1 mEq/L, blood urea nitrogen 28 mg/dL, and blood glucose 326 mg/dL. What is your patient’s fl uid balance status? What tentative nursing diagnoses would you make? What further data should you collect to confi rm or alter your tentative diagnoses? What nursing interventions may be indicated?

1. Summarize the information about this patient’s extracellular fluid (ECF) volume status, water balance, and electrolyte balance.

2. Based on this information, make a tentative nursing diagnosis for each of the following: ECF volume status, water balance, and electrolyte balance. Describe what additional data for each you need to confirm or correct your nursing diagnoses.

3. Propose types of oral fluids you would offer this patient to drink, and give your reasons.

4. Discuss your safety concerns for this patient, and outline how you would plan her care to ensure safety.

5. Plan what teaching you would do today and before the patient is discharged.

Answer 1

1.there is less intake of fluid and more loss of fluids due to diarrhoea and due to this intracellular fluid loss is more so there is compensation of fluid from extra cellular fluid so there is fluid imbalance happened at the end if it persists and electrolytes imbalances also occur.

2.Nursing diagnosis for ECF volume status:-deficient fluid volume related to persistent diarrhoea as manifested by low urine out put.

Nursing diagnosis for electrolyte balance:- risk for electrolytes imbalance (hyponatremia) related to diarrhoea as manifested by low level value of sodium i.e 128mEq/L.

3.Hypotonic fluids we have to offer to this patient because there is already less water and electrolytes .Hypotonic solutions are used when the cell is dehydrated and fluids need to be put back intracellularly. This happens when patients develop diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemia.

4.safety measures in this patient like patient may have confusion and dizziness so we have to support while off bed and monitor carefully while fluid infusion monitor intake output charting.

5.Teaching plan for this patient is mainly maintaining fluid balance and prevent dehydration and monitor urine output and sugar charting and advise the symptoms of hypoglycaemia and what to be done that time its all to be advised to patient teaching care plan before discharge the patient.