Answer the case study questions on the patient with “Hyponat…

Answer the case study questions on the patient with “Hyponatremia/Fluid Volume Imbalance” belowExplain why you choose that answer or answersJ.M. is an 83-year-old great-grandmother of five who is admitted to your clinical unit with a diagnosis of hyponatremia and fluid volume deficit. J.M. lives alone since her husband died 3 years ago. Her daughter lives nearby but is very busy working and taking care of her own grandchildren. The daughter found her mother lying on the living room couch very confused and disoriented. There were several empty bottles of water lying on the coffee table. J.M. is unable to state how long she has not been feeling well, but her daughter states that her mother has been complaining of nausea, vomiting, and diarrhea for 1 week.Question: Based on the sketchy history available for J.M., which assumption best identifies the pathophysiologic basis of her fluid and electrolyte imbalance?J.M. probably suffered a stroke and was unable to regulate her fluid intake appropriately as a result of disorientation and confusionJ.M. lost sodium-rich fluid with vomiting and diarrhea. The water that J.M. drank further diluted the sodium concentrationJ.M. lost isotonic fluid with vomiting and diarrhea, but caused a dilutional hyponatremia by drinking too much water afterwardsJ.M.’s nausea, vomiting, and diarrhea activated the renin-angiotensin-aldosterone system, cousin the release of aldosterone that further exacerbated J.M.’s fluid deficitQuestion: You admit J.M., obtain a health history, and perform a physical examination. You pay particular attention to the signs and symptoms that J.M. manifests related to her diagnosis of hyponatremia and fluid volume deficit. Identify the expected manifestations of hyponatremia and fluid volume deficit below. There are *8 correct answers.IrritabilityConfusionTachycardiaWeight gainPostural hypertensionDry mucous membranesPolyuriaBradycardiaTremorsSeizuresHypertensioncommaQuestion: On physical examination, J.M.’s skin is warm and dry with poor skin turgor. SHe also has dry mucous membranes and dark-colored urine. Which vital signs most likely correspond to these assessment findings? (choose one answer)BP: 100/62 lying, 104/64 sitting, 110/79 standing; HR: 102 lying, 100 sitting, 94 standing; Resp: 102; Temp: 37.2 degrees C (98.96 F)BP: 100/62 lying, 85/60 sitting, 80/50 standing; HR: 102 lying, 114 sitting, 130 standing; Resp: 26; Temp: 38 degrees C (100.4 F)BP: 120/82 lying, 110/64 sitting, 130/88 standing; HR: 80 lying, 70 sitting, 82 standing; Resp: 26; Temp: 37.0 degrees C (98.6 F)Question: You review the results of the laboratory tests ordered for J.M. in the emergency department. Select those findings that you would expect to be present in J.M.’s condition. There are 3* correct answers.Sodium 124 mEq/L (124 mmol/L)Chloride 106 mEq/L (106 mmol/L)Hgb 10 g/dLHct 54%BUN 35 mg/dLPotassium 4.8 mEq/LQuestion: After completing J.M.’s assessment, you develop an individualized plan of care based on nursing diagnoses appropriate to her assessment findings. You would give the highest priority to which nursing diagnosis?Risk for injury related to altered sensoriumImpaired verbal communication related to decreased LOCRisk for impaired skin integrity related to poor skin turgorDecreased cardiac output related to excessive ECF lossesQuestion: Select all of the appropriate nursing interventions that you would plan to implement during care of J.M. There are 8* correct answers.Assess intake and output every 8 hoursChange patient position slowlyAdminister oxygen to main O2 saturation greater than 95%Hourly neuro checks for sodium levels of <120 mg/dLWeigh pt dailyTurn patient every 2 hoursAssess skin turgor in the lower extremitiesPerform frequent skin care using soap to remove oilAdminister IV normal saline as orderedEnsure that sodium levels do not rise more than 0.5 mg/dL per hourOffer patient 100 mL of tap water hourlyProvide oral care every 4 hours and prnScenario: At 3:00 AM, J.M.’s blood pressure drops to 74/40. The graduate nurse calls the resident on call and receives an order from the sleepy physician to administer an IV of D5W at the rate of 200 mL/hr to treat J.M.’s hypovolemia. The graduate nurse immediately follows these instructions.Question: At 7:00 AM, the graduate nurse and you enter J.M.’s room for bedside report. You find J.M. nonresponsive and displaying generalized seizure activity. Which statement most accurately describes the cause of J.M.’s present condition?Hypovolemia causes decreased cerebral perfusion resulting in seizure activityJ.M. is displaying symptoms of septic shock related to her week-long viral activityInappropriate administration of sodium-free water causes cerebral cellular swellingFluid volume deficit causes shrinkage of cerebral cells and neuronal hyperexcitabilityQuestion: Based on J.M.’s change in condition, which nursing diagnosis is now the priority in planning care for J.M.?Risk for injury related to seizures secondary to abnormal CNS functionImpaired social interaction related to impaired sensorium and seizure activityImpaired vocal communication related to decreased LOC and seizure activityDisturbed body image related to altered body appearance secondary to seizure activityQuestion: In order to best provide emergent care to J.M., which activity would be most appropriate for you to delegate to unlicensed assistive personnel (UAP) at this time?Position J.M. on her side to prevent aspiration of secretions during seizure activityCall J.M.’s family to explain what is happening and ask if they want a DNR orderNotify the health care provider of J.M.’s status while you stay in the room with J.M.Reassess J.M.’s neurologic status every 15 minutes while you consult with the health care providerQuestion: Select all the appropriate diagnostic tests and collaborative interventions you may expect the health care provider to order for J.M. at this time. There are 8* correct answers.Assess neuro status every hour.Diazepam 5 mg IV push statPhenytoin level in AMSerum electrolytes now and every 6 hoursFurosemide 40 mg IV statFluid restriction??no free waterFosphenytoin 150 mg PE IV push now and every 8 hoursMorphine sulfate 4 mg IV push stat500 mL NaCl 3% IV to infuse over 10 hours1000 mL normal saline to infuse at 75 mL/hrVasopressin 5 units IV statScenario: J.M.’s hypovolemia and hyponatremia begin to resolve with IV fluid replacement therapy and oral fluid restrictions. You decide to teach J.M. and her daughter measures to prevent a further recurrence.Question: If you develop nausea, vomiting, or diarrhea in the future, it is important to replace fluids with ______ drinks such as Gatorade and to consult your health care provider for medications to control the nausea, vomiting, and diarrhea. Drinking only _______ to replace fluid lost as a result of vomiting and diarrhea can lead to a very serious drop in serum ______ , leading to the symptoms of ______ and ______ that you demonstrated on admission.Options to fill in blanks:BradycardiaCalorie richConfusionDisorientationElectrolyte richHypertensionPotassiumSodiumWater
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