Download File - Shawna boswell

Shawna Boswell
NURS 220
MAY 28, 2014
NURS220 Health and Illness I - Concept 7 Fluid & Electrolyte Balance
Case Study and Worksheets
• Carefully review the items found below and review current resources to provide your answers. You will be
expected to use your texts purchased for this program as well as online sources.
• Using two to five sentences per item, complete the word document and upload to your Case Study folder found in
your drop box on Laulima.
• Complete a reference page at the end using correct APA format. A minimum of five resources is required. One
current research article must be included within your document and cited at the end.
• The deadline for completion is Wednesday, May 28.
Review the model case study found on page 70 of your Giddens text and answer items.
1. Describe the basic components of heart failure. (Do not use the mechanisms cited in the case
study. Use your own resources that may include nursing or medical web-based sites.)
According to DeWitt and Kumagai (2013), “the most common cause of heart failure (HF)
are coronary artery disease and uncontrolled hypertension. Other factors that contribute
to weakness of the heart muscle are toxin, infection,, anemia, myocarditis, dilation from
blood backup behind diseased valves, and damage from myocardial infarction
(MI)"
(p. 426).
2. What do you think was occurring at the elementary school where she volunteered that resulted
in her vomiting and diarrhea? Cite the mode of transmission.
Gidden (2013) states in the case study that “Mrs. Malone volunteers at a nearby
elementary school, where earlier in the week several students were sent home sick after
vomiting. Mrs. Malone developed vomiting and diarrhea” (p. 70).
There could have been caused by bacterial, viral, or parasitic pathogens, that could have been
passed on through contaminated food, droplets from coughing or sneezing, or crosscontamination of an infective person touching an inanimate object that someone else would later
touch. Touching the face, eyes, and/or mouth with the contaminated hands can increase the risk
of contracting the pathogen, which can enter the body.
According to Copstead and Banasik (2013), “transmission of infection is defined as any
mechanism by which an infectious agent is spread through the environment to another
person. These mechanisms can be either direct or indirect” (p. 141). The authors also
state that “transmission of disease requires a chain of events that includes passing of the
pathogen from the reservoir of the infection through a portal of exit to a susceptible host
through a portal of entry by a circumscribed mode of transmission” (p. 144).
3. Using your own words, describe the mechanisms that occur with orthostatic hypotension.
Include effect of the blood pressure and heart rate.
When there is a shift in position (supine to sitting or sitting to standing) the blood pulls to the
lower part of the body and the SNS-mediated response fails, which causes a lowered blood
pressure because there is a delay in blood perfusing back to the brain and the upper body.
Copstead and Banasik (2013), states that “the standard definition of orthostatic
hypotension is a decrease in systolic blood pressure of less than/or equal to 20 mm Hg or
a decrease in systolic blood pressure that is lesser than/ or equal to 10 mm Hg within 3
minutes of moving in an upright position. Other references state that an excessive
increase in heart rate, by 20 to 30 beats/minute, is also diagnostic” (p. 345).
4. What electrolyte imbalance was occurring when Mrs. Malone began to drink more water?
Keep in mind that her diarrhea persisted and dietary intake was reduced during this time.
Fluid volume overload was occurring, as well as hyponatremia and hypokalemia. Mrs. Malone,
despite still experiencing diarrhea decreased her intake of food (toast and rice was her diet during
this time), increased her water intake, and stopped taking her KCl medicine. Her body was
losing electrolytes and was not being replenished due to her lack of food intake, so she wasn’t
replenishing the salt and potassium being lost.
5. What electrolyte imbalance was occurring when Mrs. Malone stopped taking her KCL? Were
there other factors contributing to this electrolyte imbalance?
Mrs. Malone’s potassium and sodium output were increased with the diarrhea and since she
stopped taking her KCl tablets, she was not replenishing the potassium that she was losing. She
was also on a sodium-restricted diet, so during her diarrhea episode, her diet only included rice,
dry toast, and excessive amounts of water.
Gidden states “to counteract her decreased sodium and water output, she used the
prescribed furosemide, a potassium-wasting diuretic that increases sodium and water
output. Because this diuretic also increases potassium output, Mrs. Malone also took KCl
to increase her potassium intake” (p. 70).
6. Why did the NP recommend Mrs. Malone drink broth with salt and orange juice?
The NP recommended Mrs. Malone intake broth with salt and orange juice to increase her intake
of salt, which she needed to replenish, since there was an increase of sodium and potassium
output due to diarrhea. Orange juice also has sodium, calcium, and potassium in it. Since she
stopped taking her KCl (potassium supplement) tab, her intake of potassium had decreased,
causing her potassium levels to decrease drastically (in combination with diarrhea).
7. What is the relationship between Mrs. Malone’s electrolyte imbalance and “weak legs”?
What other recommendations should have been made at this time by the nurse?
The relationship between Mrs. Malone’s electrolyte imbalance and “weak legs” are that she had
an increase of potassium output in diarrhea, which caused her to have hypokalemia. Another
recommendation that could have been made is to take an anti-diarrheal, to assist with ceasing the
diarrhea; if she continued to experience weakness in her legs and diarrhea has not stopped in the
next hour or so, visit the nearest emergency department because she may need an IV treatment of
fluids to replenish the electrolytes she has lost.
According to Gidden (2013), “safety is high priority for patients with decreased level of
consiousness from osmolality imbalances of substantial muscle weakness from severe
hypokalemia. Comfort measures are especially important for people who need to restrict
fluid or sodium” (p. 68).
8. As the nurse consultant, what time frame would you want her electrolytes to be rechecked?
To better asses Mrs. Malone, I would ask to schedule a blood draw either later during that day or
the next morning.
Davis (2011), states that “there are no food, fluid, or medication restrictions unless by
medical direction” (p. 1076).
9. Are there any other health care providers that should be considered in planning care for Mrs.
Malone? Cite a minimum of three and their role in her care.
A dietician can assist with meal preparation and menu planning, specific to Mrs. Malone’s health
needs. An RN can help assist with administration of fluid replacement, medication
administration, patient education, monitoring of symptoms of hypokalemia and hyponatremia,
and communication with physician. A physician who will prescribe needed treatments and
medications and read results from blood draw to determine further treatments to address
electrolyte imbalances.
10. Describe one provision of Medicare that supports Mrs. Malone in accessing primary care.
According to Centers for Medicare and Medicaid Services (n.d.) lists their provisions for
Medicare as “medicare is a health insurance program for: people age 65 or older, people
under age 65 with certain disabilities, and people of all ages with End-Stage Renal
Disease (permanent kidney failure requiring dialysis or a kidney transplant).”
Mrs. Malone’s age qualifies her to be a participant of Medicare services.
11. If Mrs. Malone were eligible for home care, what five objective data would the RN ask the
health care team to make? (There is an assumption here that the RN will not always be making
the home visit and according to our state Nurse Practice Act, only RNs can assess. Answer this
question as if you were providing instruction to a CNA. )
Gidden shares a guide to functional assessment screening in a table, which covers vision,
hearing, mobility, fall history, continence, nutrition, cognition, affect, home environment,
social participation, and ADLs (basic and instrumental). For vision, look for signs that
their might be impairment of vision, such as a client favoring one side to focus vision on
a particular item or direction or reaching/feeling for items; for hearing, assess client’s
ability to hear while interacting with them; for mobility, observe the client for any
limitations with range of movements, gait, and standing/sitting; for nutrition, assess the
appearance of the client and note weight if able to; for cognition, assess client’s ability to
understand and follow questions and directions and giving the client 3 items to remember
and ask them to repeat those items after a 1 minute lapse; and for affect, assess the
client’s expressions to match their mood and what they are saying (p. 15).
12. If Mrs. Malone had refused to restart her KCL, what ethical principle would she be
asserting? Does Mrs. Malone have the right to refuse this treatment? (This information may be
found in your Cherry text, chap. 9 or any resource addressing client rights).
According to the American Cancer Society’s website (n.d.), the patient bill of rights
covers many things which includes taking part in treatment decisions. “You have the
right to be informed about your treatment options and take part in decisions about your
care. You have the right to ask about the pros and cons of any treatment, including no
treatment at all. As long as you are able to make sound decisions, you have the right tot
refuse any test or treatment, even if it means you might have a bad health outcome as a
result. You can also legally choose someone who can speak for you if you cannot manke
your own decisions.”
13. What have you learned completing this case study? Equally as important, what do you think
you need to know more about to be a competent nurse managing Na+ and K+ imbalances?
I have learned that there is always a need for patient education/teaching in reference to Mrs.
Malone experiencing electrolyte loss and stopping her medication KCl, which would assist in
replenishing her potassium that was being lost in diarrhea. To help improve my skills to
efficiently and competently manage a client with sodium and potassium imbalances, I will need
to confidently and consistently be able to recognize the signs and symptoms of these imbalances,
be able to assess the client, and quickly administer the treatments that are required to improve the
clients chances of balancing their electrolytes, all while following facility/school protocols and
the chain of command.
References
American Cancer Society (n.d.). Patient’s bill of rights. Retrieved from http://
www.cancer.org/treatment/findingandpayingfortreatment/
understandingfinancialandlegalmatters/patientsbill-of-rights
Centers for Medicare & Medicaid Services (n.d.). Medicare program: general information.
Retrieved from http://www.cms.gov/Medicare/Medicare-General-Information/
MedicareGenInfo/index.html
Copstead, L. and Banasik, J. (2013). Pathophysiology (5 ed). St. Louis: Elsevier
DeWit, S. and Kumagai, C. (2013). Medical-surgical nursing: concepts and practice (2 ed). St.
Louis: Elsevier.
Giddens, J. (2013). Concepts for nursing practice. St. Louis: Elsevier
Leeuwen, A., Poelhuis-Leth, D., and Bladh, M. (2011). Davis’s Comprehensive Handbook of
laboratory and diagnostic tests with nursing implications (4 ed). Philadelphia: Davis.