Fluids Case Study Review

Fluids Case Study Review with Solutions to the nursing questions, Fluids Case Study Review: Mr. Cooper

Fluids Case Study Review: Mr. Cooper

Mr. Cooper, age 65, is a widower and lives alone. He is lethargic with hyperreflexic deep tendon reflexes. Hehad been in his usual state of good health until this week, and has no significant health history other than mild hypertension, which is being treated with diet and exercise. He takes no medications, other than a daily multivitamin. He has been vomiting persistently for 3 days with watery diarrhea, and a relative brought him to the emergency room.  On admission, he weighed 153 pounds. His original weight was 165 pounds (75 kg). The nurse assessed his fluid state and noted that his mucous membranes and skin were dry. His temperature was 99.4 F (37.5C), pulse 112, respirations 32, blood pressure 110/88, and urine output in 8 hours 125 mL with a specific gravity of 1.032. Electrolyte findings were serum K+ 3.5 mEq/L; Na+ 159 mEq/L; and Cl – 120 mEq/ L. His hematocrit and BUN were elevated. Serum glucose was 72 mg/ dl.

1. The nurse assesses Mr. Cooper’s body fluid state. Name four of his symptoms and laboratory findings that are suggestive of the fluid imbalance (dehydration): Serum electrolytes: Na+ 159 mEq/L; Cl 120 mEq/L) Vital signs: tachycardia, tachypnea, low – grade fever Weight loss (165- 153 lbs in 3 days) and low urinary output (125 mL in 8 hours) (Fluids Case Study Review with Solutions to the nursing questions, Fluids Case Study Review: Mr. Cooper)

Presentation: lethargic, dry mucous membranes and skin

Other laboratory values:

Hct, BUN, urine SG

2. Determine the percentage of Mr. Cooper’s body weight loss: (165 -153) =  12

=  7.27%

3. Mr. Cooper’s total fluid loss is:

165 -153 lbs = 12 lbs

1 kg – 12 lbs

=    12 

2.2  =  5.45 kg  =  5.45 liters of fluid loss over 3 days

2.2 lbs         1

4. Clinically, Mr. Cooper has which of the following: (Fluids Case Study Review with Solutions to the nursing questions, Fluids Case Study Review: Mr. Cooper)

a. Mild dehydration

b. Moderate dehydration (< 8%)

c. Severe

d. Fatal

5. Which type of hypernatremia is Mr. Cooper experiencing (water loss or sodium gain)? Water loss hypernatremia

6. Name the type of Mr. Cooper’s dehydration: Hypertonic dehydration

7. What is the rationale for your selection? More water loss than sodium; hypernatremia.

8. State the priority nursing diagnosis for Mr. Cooper:  Deficient Fluid Volume r/t excessive hypotonic fluid loss resulting in more solute, less body water 2 to intractable nausea and watery diarrhea, AEB: weight loss, decreased skin turgor and dry membranes, lab values, tachycardia

9. What do you, as the emergency room nurse, anticipate to be the priority nursing and collaborative  interventions for Mr. Cooper?  Assess vital signs (particularly orthostatic blood pressure, pulse) initially, to determine baseline, and then frequently throughout therapy.Start and maintain an IV line and administer fluids at prescribed rates. (Fluids Case Study Review with Solutions to the nursing questions, Fluids Case Study Review: Mr. Cooper)

Rehydration with hypotonic IV fluids (slowly)

Treat under

lying cause (medications as prescribed for nausea and diarrhea)

Rule out any infection

Careful monitoring of client response to rehydration therapy:

Blood pressure, pulse, strict I & O, daily weight, skin turgor, level of consciousness, electrolytes(especially serum sodium), urine SG, Hct, BUN

Make sure all safety precautions are in place (bed in low position, call bell within reach, side rails up X 3).

Monitor postural heart rate and blood pressure closely when getting Mr. Cooper out of bed. Have him take several minutes to get up, go in slow steps from a lying to a sitting to a standing position. Be sure someone is present when he gets out of bed.

10. What two laboratory results were indicative of dehydration other than the electrolytes? Hct , BUN; SG of 1.032

11. Which intravenous solution(s) would be most appropriate for Mr. Cooper? D5W, 0.45% NaCl

Population: Bariatric adolescents considering or undergoing gastric bypass surgery.

Intervention: The nurse’s role as a primary member of the multidisciplinary team regarding perioperative care of the bariatric adolescent patient.

Comparison: The nurse’s role as a secondary member of the multidisciplinary team without any specialized training and is only involved in the perioperative care of the bariatric adolescent patient.

Outcome: When the nurse is involved as one of the primary members in the multidisciplinary team approach, the bariatric adolescent patient has better continuity of care.

Time: perioperative including the 6 weeks post recovery.

PICOT Question: Does the bariatric adolescent patient undergoing gastric bypass have better continuity of care perioperatively and postoperatively when the nurse is a primary member of the multidisciplinary team versus when the nurse is a secondary member whose only role is in providing perioperative care and has no specialized training?

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