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Case Study 1- Hypovolemia 86-year-old male who presents with a complaint of generalized weakness, progressive over one week. Today he felt so weak that he was unable to get out of bed. When he sits up he experiences extreme dizziness. When questioned he states he has had some nausea, vomiting, diarrhea with decreased input for 3 days. An Iv is established, blood work collected and vitals taken. Vitals are: HR 122 bpm, BP 80/52, RR 18, SpO2 95% RA, 37.3. 1. What are some assessments the nurse can use to evaluate level of dehydration? 2. What are signs and symptoms of dehydration? 3. When concerned about rehydration there are several options to hydrate patients with IV therapy. Briefly explain these terms, osmosis versus diffusion, isotonic fluid, hypotonic fluid, and hypertonic fluid. 4. What fluid would you choose to rehydrate this patient, why did you choose that fluid? 5. What lab results would you expect if someone has fluid volume deficit? 6. What vital signs (BP, HR, RR, Temp, sPo2) would you expect for someone that is dehydrated? 7. What is fluid overload and how do I monitor this patient while we are administering IV fluids to ensure this patient is not fluid overloaded? Case Study 2- Hyponatremia A 28-year-old female undergoes an appendectomy. Postoperatively she is placed on 0.45% NaCl at 120 mL/h. Twelve hours later she develops a headache, nausea, and vomiting and is treated with narcotics. Twenty-four hours later she is confused and combative and is taken for an emergent head computed tomography (CT). En route to the CT, she suffers generalized tonic-clonic seizures. Rapid bedside testing reveals a serum sodium level of 122 mEq/L. 1. What are the normal ranges for sodium? 2. Is 0.45% NaCl considered hypotonic, isotonic or hypertonic? 3. What symptoms occur when someone is hyponatremic? 4. What symptoms are expected when someone is hypernatremia? 5. What precautions should a nurse take with hyponatremia? 6. This patient in the case study was out of surgery for 8 hours. How many mLs of 0.45% NaCl did she receive? 7. Where is sodium mainly found (ICF or ECF)? Case Study 3- Hyperkalemia A 60-year-old male is on vacation visiting the luscious beautiful beaches in Kihei, Maui Hawaii (the best vacation spot- you know I’m right). This patient has a history of DM, CKD, and is on dialysis. Because of the vacation he has been missed three dialysis appointments. He presents to the ED with weakness, palpitations, and increasing edema. An IV is established and blood tests have been sent to the lab. It is found that the patient’s potassium level is 7.2 mEq/L. 1. What are the normal levels for potassium? 2. What EKG changes will you see for hyperkalemia and hypokalemia? 3. What is more common hypokalemia or hyperkalemia? 4. What is more life threatening, hypokalemia or hyperkalemia? 5. How does acidosis (low pH) affect potassium levels? 6. List 5 medications that you can give to help treat hyperkalemia. Case Study- Hypocalcemia A 35-year-old-female has undergone a thyroidectomy surgery. 36 Hours after the surgery the patient reports experiencing tingling sensations in the hands, weakness, low blood pressure, and muscle twitching. She uses her call light to notify the nurse about these new symptoms. 1. What are the normal levels for Calcium? 2. What common protein in the blood effects the interpretation of calcium results? 3. Why is hypocalcemia a common problem for any thyroid or parathyroid surgery? 4. What are Chvostek and Trousseau’s sign? 5. Which form of calcium provides more ionized calcium? 6. What is calcium’s relationship with phosphate? Case Study- Hypermagnesium A 23-year-old female is preeclamptic and having a hypertensive crisis. The doctor orders the patient a magnesium infusion for the next 24 hours as recommended by the patient’s OBGYN. After starting the administration of magnesium, the patient reports she feels weird, unwell, and “crappy”. 1. What are the common signs and symptoms of hypermagnesium? 2. What precautions will you take to protect your patient while experiencing hypermagnesium? 3. Why is magnesium given for a patient with a hypertensive crisis, severe asthma attack, or preterm labor?
SCIENCE
HEALTH SCIENCE
NURSING
MED/SURG NURSING 245