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. Extra cellular fluid, water balance & electrolyte balance status

Extracellular fluid (ECF) is all the fluid outside a cell, which is divided into interstitial fluid, intravascular fluid and transcellular fluid. ECF makes up about 17% of the total body weight. Loss of transcellular fluid can produce fluid and electrolyte disturbances.

• Here it says that patient has got diarrhea for 4 days and has got weight loss of 4lb(1.8Kg).
• Diarrhea which is related to GI, again comes under transcellular fluid. GI tract plays a vital role in fluid regulation. So in case of diarrhea, GI becomes a site of large fluid loss. Thus leads to depletion of extracellular fluid volume
• Lungs is one of the organ through which water loss occurs, here the Patient has got Pneumonia, again fever too, hence it can lead to water loss.
• Sodium is the most abundant cation in ECF. Sodium ions are the major contributors to maintain Water balance. Here the patient's Sodium level is 128mEq/L, which is low. Normal level of Na in ECF is 135-145mEq/L. Main cause is Diarrhea.
• Thus electrolyte imbalance due to HYPONATREMIA affects the WATER BALANCE, and due to excess fluid loss that is transcellular fluid loss due to Diarrhea leads to DEPLETION of EXTRACELLULAR FLUID VOLUME.
• Urine output is also decreased for the patient.
• BUN level of the patient(28mg/dL) is also increased, normal is <25mg/dL, hence it is evident that due to DEHYDRATION fluid flow to kidney is diminished.
• so from all this information we can say patient has got FLUID VOLUME DEFICIT - WATER & ELECTROLYTE LOST IN EQUAL OR ISOTONIC PROPORTIONS

​​​​​​​2. Nursing diagnosis

• Deficient fluid volume related to water loss from diarrhea, fever
• Electrolyte imbalance (hyponatremia) related to diarrhea
• Decreased cardiac output
• Imapaired gas exchange
• Ineffective tissue perfusion
• Impaired skin integrity
• Imapaired oral mucos membrane
• Risk for injury

Assess patient's intake output chart

Check whether on IV fluids

Check the weight of the patient

Assess for dehydration

Assess for signs of hypovolemia

Monitor ABG.

3. ORAL REHYDRATION SOLUTION (ORS) can be given for the patient to drink inorder to correct the fluid and electrolyte imbalance. ORS contains: SODIUM CHLORIDE 2.6gm/L, GLUCOSE ANHYDROUS 13.5gm/L, POTASSIUM CHLORIDE 1.5gm/L, TRISODIUM CITRATE DIHYDRATE 2.9gm/L