Physiology/Health Promotion
Increased sodium causes a _____ of water _____ of the cells, making the cells dehydrated
shift, out
What are some manifestations associated with dehydration?
Lethargy, confusion, seizure, coma, death
What type of diet should John Doe be prescribed?
Low sodium diet
Upon admission to the ER, what abnormal findings can the RN expect to find when assessing John Doe? What specific things should the RN assess him for based on his admission Dx?
The RN should perform a head-to-to assessment paying close attention to his LOC, vital signs, and CMP values (sodium, potassium, BUN, Cr, albumin, Ca).
Abnormal findings: decreased bp, tachycardia, lethargy, etc.
Normal findings: Bp WNL (120/80) or at pts baseline, HR WNL (60 - 100 bpm), and alert.
The nurse should delegate the task of physical assessment and recording John Doe’s vitals to the ______.
LVN/LPN
Excessive sodium _____ causes ______ failure.
retention, kidney
Hypernatremia is a blood sodium level greater than ______.
145 mEq/L
If John Doe has been out working in the sun all day, he is at high risk for a ______.
Dehydration & Heat stroke
Based on the information the nurse was given, what type of precautions should John Doe be on?
Seizure precautions, fall precautions
What are some teachings that can help John Doe from fluid imbalances?
Teaching patients about s/s of dehydration and fluid overload, such as increase or decrease of urine output, a change in mental status, excessive sweating, pitting edema, swollen extremities, and rapid weight gains or weight loss. Also, teaching patients about certain foods for increasing water volume, such as melon, and bananas for hypokalemia
What are the organs that regulate acid-base balance?
Lungs & kidneys
Sodium is the major ______ in _____cellular functions.
electrolyte, extracellular
What type of IV fluids should be given to John Doe?
0.45% Sodium Chloride
What are some goals the nurse can plan for John Doe?
Stabilize him, rid his body of excess sodium by diluting it, place him on a sodium restriction diet, and maintain a patent airway.
What specialties or personnel may be involved in John Doe's case?
Nurse, LVN/LPN, tech, registered dietician, hospitalist, nephrologist, cardiologist, and gastroenterologist
What are some things the nurse can encourage John Doe to do in order to promote his health?
Improve diet, stay hydrated on the job, stop drinking or at least prevent excessive alcohol use.
Name some diagnostic procedures that can be done on John Doe.
Blood test (Complete Metabolic Panel), EEG (electroencephalogram), urine test (urine analysis), ECG/EKG (electrocardiogram)
What is the fractional amount of sodium that will be mixed with water in the NaCl solution?
½ Sodium and more water
What interventions can be done to help treat John Doe?
1) Pad the bed as a seizure precaution: High levels of sodium may cause muscle twitching with loss of consciousness and seizures leading to death if hypernatremia is not corrected (Assessment Technology Institute, 2022)
2) Administer 0.45% NaCl IV: By administering 0.45 NaCl IV solution, it will move water from the extracellular fluid into the cells without excess solute (Assessment Technology Institute, 2022). Infuse IV solution as ordered and calculate the IV flow rate to prevent fluid overload.
3) 2g Sodium diet (consult with a dietician): Limiting sodium help prevent rapid heartbeat, low blood pressure, change in mental status, and seizures (Ackley et al.,2020, p.362)
4) Limit alcohol intake: Alcohol is a diuretic that will eliminate water from the body system. Therefore, kidneys are poorly perfused, and a drop in glomerular filtration rate (gfr) may cause deterioration in kidney function (Ackley et al., 2020, p. 409)
What are some treatments that will prolong John Doe's life if he were to go into organ failure or kidney failure?
Dialysis, organ transplant, management of symptoms and pain, and comfort care/end-of-life care
What type of foods can be implemented in John Doe’s diet?
Chicken, turkey breast, unsalted nuts and seeds, dried beans, peans, lentils, blackberries, strawberries, bananas, fried rice, hummus, pasta salad
What are the indications of a person that is hyperkalemic on an ekg/ecg test?
Elevated T waves
If impaired kidney excretion is the cause of John Doe’s hypernatremia, _____ should be administered.
diuretics (loop diuretics)
What things should be monitored and evaluated?
Level of consciousness, I&O, heart rate, BP, auscultating for breathing sounds and heart sounds.
How do you think John Doe being a single father, contributed to his ER admission?
Since John Doe is a single father, he has to be able to contribute to his family through his income alone. He has to work two jobs and is most likely overworked and burnt out most of the time.