Fluid Balance
An older adult with limited thirst has lost 1.1 kg in 48 hours, becomes lightheaded on standing, and has increasingly concentrated urine. This problem best explains the full cue cluster.
What is hypovolemia, or deficient fluid volume?
A client has potassium 2.8 mEq/L after loop-diuretic therapy. Before giving replacement, this function must be confirmed because it determines whether the administered potassium can be excreted.
What is adequate kidney function and urine output?
ABG results are pH 7.28, PaCO2 31 mm Hg, and bicarbonate 17 mEq/L after several days of diarrhea. Identify the primary disorder and compensation.
What is metabolic acidosis with respiratory compensation?
Hemoglobin is low, MCV is 72 fL, ferritin is low, and TIBC is high. This diagnosis best integrates the pattern.
What is iron-deficiency anemia?
A parenteral nutrition infusion is unexpectedly interrupted while prescribed insulin may still be active. This parameter requires immediate bedside reassessment.
What is blood glucose?
Serum sodium is 126 mEq/L, serum osmolality is low, urine remains concentrated, and weight has increased without an identified sodium loss. This mechanism best explains the findings.
What is impaired free-water excretion causing dilutional hyponatremia?
A client with potassium 6.4 mEq/L and ECG changes receives IV calcium gluconate. This is the immediate therapeutic purpose of the calcium.
What is stabilization of the cardiac membrane?
ABG results are pH 7.49, PaCO2 46 mm Hg, and bicarbonate 33 mEq/L after prolonged vomiting and gastric suction. Identify the primary disorder and compensation.
What is metabolic alkalosis with respiratory compensation?
Macrocytosis is accompanied by loss of vibration sense, gait instability, and chronic autoimmune gastritis. This deficiency best explains both the blood and neurologic findings.
What is vitamin B12 deficiency, or pernicious anemia?
Fifteen minutes after a blood transfusion begins, the client develops chills, lumbar discomfort, and anxiety. This is the nurse's first action.
What is stop the transfusion and maintain IV access with normal saline using new tubing?
Maintenance saline runs at 100 mL/hr, and a second order replaces measured gastric losses. The handoff does not state whether the replacement is included in maintenance. This is the nurse's next step.
What is clarify whether replacement is additional to the maintenance volume?
After insulin and dextrose are given for hyperkalemia, the potassium improves. This delayed complication still requires surveillance because insulin action can outlast the initial dextrose effect.
What is hypoglycemia?
A client with stable COPD has pH 7.36, PaCO2 58 mm Hg, and bicarbonate 32 mEq/L. This interpretation explains why the pH is near normal despite persistent carbon dioxide retention.
What is chronic respiratory acidosis with metabolic compensation?
An adult has fatigue, recurrent infections, bruising, pancytopenia, and a markedly hypocellular bone marrow. This disorder best explains the findings.
What is aplastic anemia?
A prescription reads potassium chloride 40 mEq in 100 mL to infuse through a peripheral line over 30 minutes. This action is required before administration.
What is hold the infusion and clarify the unsafe rate or concentration?
During treatment of severe chronic hyponatremia, sodium rises from 112 to 120 mEq/L in 8 hours, nearly reaching the prescribed 24-hour correction limit. This response is indicated now.
What is stop or slow the correction and notify the prescribing team?
Potassium remains 2.9 mEq/L despite prescribed replacement, and magnesium is 1.2 mg/dL. This concurrent treatment best addresses the reason potassium is difficult to correct.
What is magnesium replacement along with continued potassium management?
A distressed client has perioral tingling, pH 7.52, PaCO2 27 mm Hg, and bicarbonate 22 mEq/L. This acid-base disorder best accounts for the cue cluster.
What is acute respiratory alkalosis?
A client with sickle cell disease develops rapidly increasing left upper-quadrant fullness, hypotension, an abrupt hemoglobin drop, and reticulocytosis. This complication is most likely.
What is acute splenic sequestration?
A client with platelets of 18,000/mm3 needs oral care. This plan best balances bacterial control with prevention of mucosal bleeding.
What is gentle oral care with a soft toothbrush while assessing for trauma or bleeding?
The chart shows intake of 3,000 mL, output of 1,200 mL, and a recorded balance of only plus 300 mL. Parenteral nutrition and line flushes were omitted. This action comes before interpreting the trend.
What is reconcile and total every fluid source?
Two days after nutrition is restarted in a severely malnourished client, phosphate, potassium, and magnesium fall while edema and weakness develop. This process explains the combined trend.
What is refeeding syndrome?
A septic client has pH 7.40, PaCO2 20 mm Hg, and bicarbonate 12 mEq/L. The PaCO2 is lower than expected for compensation alone. This interpretation fits the data.
What is mixed metabolic acidosis and respiratory alkalosis?
Hematocrit is 60%, erythropoietin is low, and the client reports aquagenic pruritus and burning red fingers. This myeloproliferative disorder best fits the cluster.
What is polycythemia vera?
A client with severe anemia has oxygen saturation 98% but develops tachycardia and dyspnea with minimal activity. This explains why the saturation does not settle tissue oxygen delivery.
What is saturation measures hemoglobin occupancy, not total oxygen content?