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Question asked by: Nurseit24 - 5 months ago

Question

Explain to me the following topic in detail: Patient: S.S. is a 63-year-old white woman with acute lymphocytic leukemia, who has been receiving chemotherapy on an outpatient basis. She completed her third treatment 5 days ago and has been experiencing nausea and vomiting for 2 days despite using ondansetron (Zofran). S.S.s daughter brings her to the hospital, where she is admitted to the medical unit.
Subjective Data: Complaints of lethargy, weakness, dizziness, and dry mouth. States she has been too nauseated to eat or drink anything for 2 days.
Objective Data: Heart rate 110 beats/min with a thread pulse, BP 100/65. 5lb weight loss since her chemotherapy treatment 5 days ago. Dry oral mucous membranes.
Questions:
1. Based on the clinical findings, what fluid imbalance does S.S. have?
2. What additional assessment data should you obtain?
3. You draw a serum chemistry. What electrolyte imbalances are likely and why?
4. S.S. is at risk for which acid-base imbalance? How would the body compensate?
5. The physician orders 0.45% saline to infuse at 100 mL/hr. What type of solution
is this, and how will it help S.S.s fluid imbalance?
6. What are the priority nursing interventions for S.S.?
1. A client has the following electrolyte results: Na 133 mEq/L, K 3.4 mEq/L. Which of the following treatments likely resulted in these results?
a. Three tap water enemas
b. Normal saline 50 mL/hr
c. Dextrose 5% in Water (D5W) with K 20 mEq 80 mL/hr
d. Administration of glucocorticoids
2. A potassium level of 5.4 mEq/L should alert the nurse to assess the client for:
a. ECG changes
b. Constipation
c. Polyuria
d. Hypertension
3. The nurse should closely monitor a client who has a nasogastric tube for suctioning for which of the following electrolyte imbalances?
a. Hypokalemia
b. Hypocalcemia
c. Hyperkalemia
d. Hypernatremia
4. List what the LPN should observe for when checking a peripheral IV site every 1-2 hours:
5. For each of the following client findings, note which electrolyte imbalance(s) is/are supported by the finding.
Client Finding Hyponatremia Hypernatremia Hypokalemia Hyperkalemia
Serum Sodium 125 mEq/L
Serum Sodium 150 mEq/L
Serum Potassium 5.4 mEq/L
The explanation should be written at the level of the University.

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Answer

S.S. is a 63-year-old woman with acute lymphocytic leukemia who has been experiencing nausea and vomiting for 2 days despite using ondansetron (Zofran) after completing her third chemotherapy treatment. She presents with complaints of lethargy, weakness, dizziness, and dry mouth, and has not been able to eat or drink anything for 2 days. Objective data shows a heart rate of 110 beats/min with a thread pulse, BP of 100/65, a 5lb weight loss since her chemotherapy treatment 5 days ago, and dry oral mucous membranes.

1. Based on the clinical findings, S.S. likely has a fluid imbalance of hypovolemia, indicated by her low blood pressure, tachycardia, and weight loss.

2. Additional assessment data that should be obtained includes a thorough review of S.S.'s recent fluid intake and output, as well as a review of her recent chemotherapy treatments and any other medications she may be taking.

3. A serum chemistry should be drawn to assess S.S.'s electrolyte imbalances. Given her symptoms and clinical presentation, she is likely experiencing hypokalemia and hyponatremia. The hypokalemia may be due to the nausea and vomiting leading to decreased potassium intake, while the hyponatremia may be due to fluid loss from vomiting.

4. S.S. is at risk for metabolic acidosis due to her prolonged vomiting, which can lead to a loss of bicarbonate. The body would compensate for this by increasing respiratory rate to blow off carbon dioxide and reduce acidity in the blood.

5. The physician orders 0.45% saline to infuse at 100 mL/hr. This is a hypotonic solution, which will help S.S.'s fluid imbalance by providing free water to rehydrate her cells and increase her blood volume.

6. Priority nursing interventions for S.S. include monitoring her vital signs, intake and output, and electrolyte levels; administering prescribed IV fluids and medications; and providing supportive care to alleviate her symptoms.

1. The likely treatment that resulted in the electrolyte results of Na 133 mEq/L and K 3.4 mEq/L is c. Dextrose 5% in Water (D5W) with K 20 mEq 80 mL/hr, as this solution contains potassium and may have contributed to the low potassium level.

2. A potassium level of 5.4 mEq/L should alert the nurse to assess the client for a. ECG changes, as hyperkalemia can lead to cardiac arrhythmias and ECG changes.

3. The nurse should closely monitor a client who has a nasogastric tube for suctioning for a. Hypokalemia, as suctioning can lead to potassium loss.

4. When checking a peripheral IV site every 1-2 hours, the LPN should observe for signs of infiltration, such as swelling, pain, coolness, or leakage at the site, as well as assessing the flow rate and patency of the IV line.

5. The client finding of Serum Sodium 125 mEq/L supports hyponatremia, while Serum Sodium 150 mEq/L supports hypernatremia. The finding of Serum Potassium 5.4 mEq/L supports hyperkalemia.

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