help with case study

VickyRN, MSN, DNP, RN · Sep 23, 2005

I need assistance with this case study for class... 87 year old female was found motionless on the floor and appears to have been ther for a couple of days... what kind of fluid and electrolyte imbalance do we suspect.. im confused because there are no signs/symptoms for a particular one....

On the floor for a couple of days... hasn't been able to eat or to DRINK (hint: think DEHYDRATION). What F & E imbalances do you see with dehydration?

pv2007 · Sep 23, 2005

On the floor for a couple of days... hasn't been able to eat or to DRINK (hint: think DEHYDRATION). What F & E imbalances do you see with dehydration?

Thanks i was thinking that but needed a boost of thought along the way.....

Nickle · Sep 23, 2005

This is not fluid/electrolyte - but if she's been on the floor for more than a few hours, I might also expect to see an elevation in the total CK level.

Bonus points, perhaps! :chuckle

papawjohn · Sep 24, 2005

Hey PV

Your Pt's problems only started when she was unable to get water and nutrition. As suggested, the tissue damage from lying on the floor will have caused many of her body's cells to deteriorate and die. They release their contents into the bloodstream and so we find her CK elevated. There are other proteins that flood the circulation and clog up her kidneys. This is called 'rhabdomylosis' (check my spelling!!). In my experience, renal failure is the main cause of mortality in Pt's with this history.

They are generally immoble on the floor, so have pneumonia fairly often. (CO2 is an electrolyte too, ya 'member.)

Think---why was she on the floor in the first place. Expect to 'rule-out' a hip Fx. (And CALCIUM is one, too.)

So priorities are like:

Respiratory (lots of these poor souls are on vents)

Renal (rhabdo- and fluid/electrolytes)

Orthopedic (expect to look at XRay/CT results)

Wound care/infection prevention related to her Decubitus (there will be cultures of the wounds, blood Cx's, etc. If I were your teacher, I'd expect you to know the WBCs too.)

Papaw John

(of coorifice--if this is a case study of only fluids/electrolytes instead of a care plan, praise the gods who look after nursing students. A care plan for this lil' lady would have kept me up ALL NITE.)