Question

CASE SCENARIO:

An 80 year-old woman fell in her home. She is evaluated in the emergency room and is found to have a hip fracture. She was recently started with hydrocholorothiazide to treat her hypertension. She has been on an SSRI for depression following the loss of her husband and is taking NSAIDs for pain associated with osteoarthritis. Her vitals are stable. She is lethargic and disoriented but otherwise appears well. Laboratory works reveals Na – 105 mEq/L, K – 3.2 mEq/L, BUN – 32 mg/dL, Creatinine – 1.0 mg/dL.

1. Would this case suggest hypovolemia? If it is a case of hypovolemia, what was the cause and what type is it?
2. How would you manage this patient?
3. What are your nursing priorities in providing care to this patient?
4. Provide the title of the case scenario based on the cause of the problem.

Answer 1

Answer : 1) Here, patients Blood Urea Nitrogen level is higher than the normal level . It means that the patient has hypovolemia due to  reduced renalflow. Low fluid volume is not sufficient to excrete waste products from the kidneys. Then the BUN level rises in the blood . Patient become lethargic and irritable due to hypovolemia . Electrolyte imbalance is also common in hypovolemic shock . In this case , patient has absolute hypovolemia  defined as a reduction in total blood volume .It can be treated by administering colloids , plasma or fluids . 2)a ) replacement  of IV fluids according to doctors advise 2) correct electrolyte imbalance by sodium and potassium supplements. c) adequate blood , plasma or cryo  transfusion according to doctors advise . d) start inotropes for raising blood pressure e) provide vadopressors to improve blood pressure and renal dose . Nurses have to1) strictly monitor vital signs and rhythm for shock 2) monitor intake and output 3) administer oxygen 4)check electrolytes and Hb frequently 5)avoid giving fluids by mouth to prevent aspirations . 4) Causes , symptoms , and   management of hypovolemia .