Diagnosis
What is the primary diagnosis for Eva?
Gastroenteritis (infection and inflammation of the digestive system)
Hypokalemia is often seen with dehydration. When repleting potassium what are some nursing considerations?
Administer oral drug after meals or with food and a full glass of water to decrease GI upset. Caution patient NOT to chew or crush tablets, have patient swallow tablet whole! IV potassium burns and may cause phlebitis. IV potassium CAN NOT be infused quickly- slow drip/push or may cause arythmias! (monitor tele)
What is the normal lab range for potassium?
3.5-5.0 mEq
Fill in this nursing diagnosis: Deficient _____ Volume related to persistant vomitting and diarhhea
Deficient Fluid Volume
What are some other assessment findings the RN may see in a patient with dehydration?
abnormal labs (such as BUN, creat, electrolytes), abnormal vitals (such as HR, RR and BP), cap refill may be prolonged, sunken eyes, pale dry mucous membranes, skin tenting, oliguria, decreased intake, weight loss, etc
Eva is also dehydrated. What evidence can the RN use to determine this diagnosis in this vSim?
loose stooles & vomitting x3 days, pale, lethargic, decreased urination, inability to keep fluids down, dry mucous membranes
Why does the doctor not order an anti-diarrheal to slow the loose stools?
These are only used in the absense of bacterial and viral infections! We could be causing harm if we kept this bacteria in the gut or colon. Immodium, kaopectate and pepto-bismol should be used with caution in these situations.
Name another electrolyte imbalance the RN might suspect in dehydration?
Sodium or hypernatremia. SO much water is lost that sodium is elevated!
Eva has been diagnosed with dehydration. A goal for Eva is: Patient will maintain fluid volume at a functional level as evidenced by urine output of 30ml/hr during this shift. Name some nursing interventions for this goal.
Weigh pt daily and compare with 24-hour intake and output.
Monitor urine output. Measure or estimate fluid losses from all sources.
Evaluate pt’s ability to manage own hydration.
Learn pt’s beverage preferences, and set up a 24-hour schedule for fluid intake. Encourage foods with high fluid content.
Manage IVF as ordered.
What age patients are MOST at risk for dehydration and why?
Infants and elderly! These populations loose fluids easier. Babies require a higher water content than adults. Smaller body mass makes minor changes in fluid balance more dangerous. Babies (and sometimes older adults) can’t express their thirst like an adult. As we age our body changes (kidneys) and we see changes in the water and sodium balance
Name a common cause for gastroenteritis.
virus, bacteria, or parasites. Norovirus is a common cause for gastroenteritis (stomach flu) salmonella or e.coli are common culprits
After treating the dehydration, the PCP needs to address the underlying cause. If the stool culture came back abnormal, what kind of medication might be ordered?
in some cases, the patient may need antibiotics if the stool culture grows bacteria or other organisms.
The urine sample ordered for Eva comes back. What might the nurse expect to see in the urine sample?
The color and clarity of urine, the urine's specific gravity (the ammount of urine compared with water), and the presence of ketones (carbon compounds that signify dehydration) in the urine may all help to indicate the degree of dehydration. Glucose also may be abnormal
What are some of the priority nursing interventions for this patient?
replenishing lost fluids, correcting electolyte imbalances, educating family and patient on disease and diet progression, address mother's anxiety, reassess vitals, etc
Name 2 risk factors for dehydration?
Age, high or low BMI, infection, dementia, DM, diuretic use, altered renal function, caffiene intake, heat exposure, wounds/burns, ostomies, etc
Dehydration can be classified as mild, moderate or severe. What level of dehydration is Eva and what evidence would the nurse use to support this?
Moderate-Severe. Multiple symptoms of dehydration are present. Tired, oliguric, weight loss, dry mucous membranes, etc
Which of the following is the best IV fluid to give in dehydration? isotonic, hypotonic or hypertonic?
initially, isotonic fluids suchs as LR or NS will be ordered as they have the same concentration as the blood and stay in the intravascular space instead of moving fluid in or out of the cells. this will increase volume. hypotonic solution shifts fluid out of cell and hypertonic shift fluid into cell.
The PCP also ordered a chem or a CMP for Eva the next morning. What are some components of this lab panel?
BUN, creat, glucose, potassium, calcium, sodium, chloride, ALT, AST, etc
Give one SMART goal for a patient experiencing dehydration
Specific? Measurable? Achievable? Realistic? Timely?
True or Flase: dehydration makes you sleepy.
True! Dehydration effects the brain and muscles so it absolutely can present as sleepiness, tiredness or fatigue.
Eva's mother is also a priority as we consider "family-centered care". What is an appropriate nursing diagnosis for Eva's mother?
Anxiety related to unfamiliar enviroment, Deficient Knowledge related to disease process and diet, etc
Eva may need an anti-emetic to manage her nausea and vomitting. Can you name a common anti-emetic used for nausea?
Zofran, phenergan, compazine, etc. these drugs reduce rates of vomitin and improve short-term tolerance of oral fluids.
What does the abbreviation BUN stand for?
Blood Urea Nitrogren (measures how much of the waste product you have in your blood- kidneys are the blood filters!). Shows how well kidneys (and liver) are working
The nurse reads Eva's careplan goal written by another RN. The goal reads: Will eat 50% of her meal tray. What is missing from this SMART goal?
Name an abnormal vital sign seen in dehydration.
hypotension, tachycardia, or tachypnea