I have a case study to do and I'm having a lot of trouble with it, even though it shouldn't be that difficult. Each question must be answered in 3-5 sentences. Here is the information:
Mr. B is a 78yo patient admitted for chest pain. He reported not eating or drinking much on the day of admission. PMH past medical hisotry includes CAD and HTN. His IV fluid order is for D5 1/2NS. The RN assigned to the patient changes the IV bag at the end of his shift at 7am. He gives report to the oncoming nurse. The day nurse is behind in her assessments and does not see Mr. B until halfway through her shift. Mr. B tells her he is having difficulty breathing. A physical assessment reveals bilateral rales and marked edema. The day nurse finds that 0.9NS 9% normal saline is infusing .
1) Are there any other nursing assessments the RN should do?
2) What interventions would be appropriate for Mr. B?
3) How could infusing 0.9NS affect Mr. B's labs?(specifically Na and K+)
4) Why does Mr. B have bilateral rales?
5) Explain what types of fluids D51/2NS and 0.9NS are and list their indications.
6) List 3 nursing diagnoses with the R/T s.
1) Vitals (specifically looking for tachycardia and elevated bp), body weight changes, I & O, check for distended neck veins, assess Na and K+ levels
2) discontinue IV immediately, elevate head of bed, O2 therapy, diuretics
3) D5 ½ NS = 77 mEq sodium; 0.9% NS = 154 mEq sodium. Risk for elevated Na levels, therby creating low K+ levels due to the sodium-potassium inverse relationship.
4) I know this has to do with the edema, but not really sure what else or how to expand on that.
5) D5 ½ NS is a hypertonic solution. Shifts fluid back into circulation/vascular expansion/replaces electrolytes.
0.9 NS is isotonic. No fluid shift/vascular expansion/electrolyte replacement.
6) Ineffective Breathing pattern r/t pulmonary edema
Fluid Volume Excess r/t ...?
Can someone help me see the big picture so I can put it all together? I seem to be missing a lot, and don't really know what else to do.