Case Study: Fluid and Electrolytes Imbalance Week 2 of 4 is due 01/28/18 by 1159
ID: 237929 • Letter: C
Question
Case Study: Fluid and Electrolytes Imbalance
Week 2 of 4 is due 01/28/18 by 1159 pm EST
Clinical Reasoning, Decision Making and Critical Thinking
We will use this scenario and build on it over the next 4 weeks.
Now, Mr. Donald had a partial colectomy and a colostomy, day 1 post-op. Morphine via PCA pump and an IVF NS + 20 mEq KCL at 75 mL/hr. Experienced insomnia and required 2 bolus of Normal Saline for hypotension. He has a hemovac and it drained 200 mLs of serous sanguinous drainage over 24 hours. Surgical dressing to the mid abd area dry and intact. He has a colostomy bag, currently with no effluent noted. Oxygen via nasal cannula at 4 L/min. O2 sat 95% on 02 at 4L via nasal cannula. Blood sugar are well controlled. He lives alone.
*****In part 1 of 4 you considered the patient situation and collected relevant cues and information.
Part 2 of 4 will focus on PROCESSING INFORMATION
The next step of the clinical reasoning cycle is to interpret the data (cues) that you have by carefully analyzing and then applying your knowledge about fluid and electrolyte balance. Remember you must know normal versus abnormal finding to get a complete understanding of Mr. Donald’s signs and symptoms.
Temperature
37.0 C
Heart rate
118
Respiratory rate
22
Blood pressure
92/50
Oxygen saturation
96%
Hourly urine output
27 ml/hr
Blood sugar
74 mg/dl
Which of the following of the vital signs are considered to be within normal parameters for Mr. Donald. What are the normal values for the other vital signs? (2 points)
Temperature
Pulse rate
Respiratory rate
Blood pressure
His 02 sats are OK, right. A normal 02 sat level for Mr. Donald would be: (2 points)
80-85%
85-90%
90-95%
95-100%
True or false. Rational for your answer 3 points each. ½ point deducted for incorrect rational. Refer to the table
T or F
Rational
He is hpertensive from excessive IV fluids
T or F
Rational
He is hypoxic as a result of the extended anesthetic period
T or F
Rational
He is hypotensive from the preoperative bowel prep
T or F
Rational
He is hypertensive as a result of surgical blood loss
T or F
Rational
He has a post operative wound infection
T or F
Rational
He has severe postoperative pain
T or F
Rational
He is oliguric from hypotension
T or F
Rational
Now that we identified the relationships above, let’s make inferences based on your analysis. From what you know about your patient’s, Mr. Donald’s history, surgery, s/s,you’re your knowledge about fluid balance, which of the two inferences are correct and include the rationals: 5 points
Normotensive and bradycardic
Hypertensive and tachycardic
Febrile and normotensive
Oliguric and tachycardic
Hypertensive and afebrile
Polyuric and hypotensive
Hypotensive and afebrile
Part 2 of 4, 30 possible points.
************************************************
Case study 1 of 4, already done. Refer to it as needed
Scenario:
Patient is a 68-year male patient who has a history of fluid and electrolyte imbalance. Mr. Donald is status post coronary artery bypass graft (CABG) 3 days ago. He also has multiple co-morbidities, colon cancer, anemia, and hypertension. Alterations in fluid and electrolyte status are common in the elderly population. Therefore, maintaining and managing fluid and electrolyte balance is of utmost importance in preventing avoidable events, complications and mortality.
Mr. Donald has a history of colon cancer and sought treatment as soon as he noted visible blood in his stool. His bowel patterns are not regular as he experience severe diarrhea or constipation. Gastroenterologist was consulted by the attending physician.
Effective clinical reasoning and decision making skills will aid you in recognizing and managing patient’s change of condition. Oh, I failed to mention, also noting early s/s and intervening in a timing manner.
First, we need to collect relevant data about his current condition. Review the following data:
Temperature
37.0 C
Heart rate
118
Respiratory rate
22
Blood pressure
92/50
Oxygen saturation
96%
Hourly urine output
27 ml/hr
Blood sugar
74 mg/dl
____________________________________________________
Rational
Explain, what physiological changes or compensatory mechanism is causing these symptoms?
a
Color
Pale
b
Oral mucosa
Dry tongue with furrows
c
Level of thirst
Extremely thirsty
d
Pain level
4
e
Appetite
Poor
f
Cognitive state
Restless and anxious
g
Urine
High specific gravity
While relevant data requires you to review current information, it also mandates that you gather new information (recall related knowledge - anatomy, physiology, pathophysiology, pharmacology, etc).
Therefore, a strong foundation of nursing knowledge is needed to help you synthesize and apply that knowledge to nursing practice (I cannot emphasize this enough).
___________________________________________________________________
Temperature
37.0 C
Heart rate
118
Respiratory rate
22
Blood pressure
92/50
Oxygen saturation
96%
Hourly urine output
27 ml/hr
Blood sugar
74 mg/dl
Explanation / Answer
Which of the following of the vital signs are considered to be within normal parameters for Mr. Donald. What are the normal values for the other vital signs? (2 points)
Temperature
Pulse rate
Respiratory rate
Blood pressure
Ans : Temperature is in normal parameters.
The normal values of other vital signs are as followes
Pulse rate 70-80 beats /mt
Respiratory rate 12-18 res/mt
Blood pressure 120/80mm Hg
His 02 sats are OK, right. A normal 02 sat level for Mr. Donald would be: (2 points)
80-85%
85-90%
90-95%
95-100%
Ans: 95%
True or false. Rational for your answer 3 points each. ½ point deducted for incorrect rational.
Refer to the table
T or F
Rational
He is hpertensive from excessive IV fluids
F
No , he is hypotensive since the normal blood pressure levels are 120/80 Hg
He is hypoxic as a result of the extended anesthetic period
F
Not hypoxic , since he has o2 sat level is with in normal i.e 95%
He is hypotensive from the preoperative bowel prep
F
He is hypotensive because has a hemovac and it drained 200 mLs of serous sanguinous drainage over 24 hours.
He is hypertensive as a result of surgical blood loss
F
He is not hypertensive , since his blood pressure is 92/50 mmHg, and due to blood loss hypovolemia occurs and causes hypotention, but not hypertention.
He has a post operative wound infection
F
No wound infection, since,surgical dressing to the mid abdominal area is dry and intact. Even though with a colostomy bag, currently with no effluent noted.
He has severe postoperative pain
F
No Pain due to administration of morphin via cpa pump
He is oliguric from hypotension
T
He is oliguric due to hypovolimia and further hypotention since urine output is 27ml/hr
Now that we identified the relationships above, let’s make inferences based on your analysis. From what you know about your patient’s, Mr. Donald’s history, surgery, s/s,you’re your knowledge about fluid balance, which of the two inferences are correct and include the rationals: 5 points
Normotensive and bradycardic
Hypertensive and tachycardic
Febrile and normotensive
Oliguric and tachycardic
Hypertensive and afebrile
Polyuric and hypotensive
Hypotensive and afebrile
Ans: Mr. Donald had a partial colectomy and a colostomy, day 1 post-op. Morphine via PCA pump and an IVF NS + 20 mEq KCL at 75 mL/hr. Experienced insomnia and required 2 bolus of Normal Saline for hypotension. He has a hemovac and it drained 200 mLs of serous sanguinous drainage over 24 hours. Surgical dressing to the mid abd area dry and intact. He has a colostomy bag, currently with no effluent noted. Oxygen via nasal cannula at 4 L/min. O2 sat 95% on 02 at 4L via nasal cannula. Blood sugar are well controlled. He lives alone.
Oliguric and tachicardiac
Hypotensive and afibrile ,
These two statements are correct because, he lost the serous fluid , which also indicated through urinary output, Mr Donald’s urinary output is 27ml/hr. And the heart rate is 118/mt which should be arround 70-80/mt.And obviously in hypovolemia the heartrate increases to compensate the volume to vital organs.
He is hypotensive due to the serous sanginous fluid loss and also due to the surgery he also has a colostamy bag to messure.Afebrile since the temp is normal which is 37 oc
Rational
Explain, what physiological changes or compensatory mechanism is causing these symptoms?
a
Color
Pale
Due to blood loss in stools , causing anemia where hemoglobin is reduced
b
Oral mucosa
Dry tongue with furrows
c
Level of thirst
Extremely thirsty
Due to fluid and electrolyte imbalance
d
Pain level
4
Along with CABG has multiple morbitities
e
Appetite
Poor
Colonal Ca ,and anemia may reduce the appatite
f
Cognitive state
Restless and anxious
Due to Multiple morbidity
g
Urine
High specific gravity
Oliguria causes high sp gravity due to concentrated urine.
T or F
Rational
He is hpertensive from excessive IV fluids
F
No , he is hypotensive since the normal blood pressure levels are 120/80 Hg
He is hypoxic as a result of the extended anesthetic period
F
Not hypoxic , since he has o2 sat level is with in normal i.e 95%
He is hypotensive from the preoperative bowel prep
F
He is hypotensive because has a hemovac and it drained 200 mLs of serous sanguinous drainage over 24 hours.
He is hypertensive as a result of surgical blood loss
F
He is not hypertensive , since his blood pressure is 92/50 mmHg, and due to blood loss hypovolemia occurs and causes hypotention, but not hypertention.
He has a post operative wound infection
F
No wound infection, since,surgical dressing to the mid abdominal area is dry and intact. Even though with a colostomy bag, currently with no effluent noted.
He has severe postoperative pain
F
No Pain due to administration of morphin via cpa pump
He is oliguric from hypotension
T
He is oliguric due to hypovolimia and further hypotention since urine output is 27ml/hr