Fluid & Electrolyte Assistance

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Hi Everyone,

I am working on a case study and I am having trouble understanding the concept. Here is what it says... "The client provides a stool sample to test for bacterial and has an IV of 0.9% N/S solution started at 125 ml/hr in her right hand with a 22-guage IV. The client is admitted to the hospital with the diagnoses of dehydration and hypokalemia. The next day a flexible sigmoidoscopy reveals severe ulcerative colitis. Her am labs show: Hgb & Hct is 8.2/dL and 30.4g/dL, her serum potassium is 2.9 mEq/L."

Now I would have assumed her H & H would have returned to normal after being rehydrated. Or due to blood loss and inflamation--would her H &H have dropped? I thought dehydration caused an increase in the H & H. I am so confused. Than I have to start to think about what type of fluid deficit she was in.. hypertonic or isotonic? I would have assumed isotonic since she is being given isotonic fluid replacement?? Could someone please guide me in the right direction. The question I need to answer is Why the sudden drop in her H & H? Thanks guys!

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Here's a little push in the right direction :typing . You bring up a good point about being rehydrated and mentioning the potassium. But you have to remember that with UC, you commonly will have bleeding. With the H&H being what it is....and you said "severe" ulcerative colitis, I bet it's safe to say the pt had a good amount of blood in the stools, that will lead to the anemia(which it has inge the Hgb is below 10)...and 125ml/hr of NS may or may not(more likely not) correct the problem within 24 hours. The potassium, I would expect the doc to order some KCl in the IV or something for that. Hope that helped just a tad

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http://www.labtestsonline.org/understanding/conditions/inflammatory_bowel.html

It might help you, it has good info.

The HCT will rise if the number of RBC's increases or when the plasma volume is reduced-dehydration. In UC the H&H will decrease due to the inflammation and GI bleeding.

I believe isotonic is usually given initially because it stays in the circulating volume so it won't cause a fluid shift. If someone is hypertonic then a diuretic is usually given, unless it's a condition like ascites. I wish I could double check, but I don't have my books with me. Good luck!

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I have no idea what "inge" meant haha. But does it sort of make sense?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

a case study means you are doing problem solving which means you should be using the nursing process to help you critically think through this. the first step in any problem solving involves assessment. with case studies some of this assessment information is often supplied to you. some of the components of assessment include:

  • a health history (review of systems) - admitted to the hospital with the diagnoses of dehydration and hypokalemia. a flexible sigmoidoscopy reveals severe ulcerative colitis.
  • performing a physical exam - this information is missing and probably has some of the clues that are missing and needed to find the answers to some of your questions
  • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
  • reviewing the pathophysiology, signs and symptoms and complications of their medical condition - hgb & hct is 8.2/dl and 30.4g/dl and serum potassium is 2.9 meq/l. the pathophysiology, signs and symptoms of ulcerative colitis need to be looked up and read about:

    [*]reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - flexible sigmoidoscopy, iv of 0.9% n/s solution

now i would have assumed her h & h would have returned to normal after being rehydrated.

your assumption is incorrect. if the h&h have not returned to normal levels then something else is going on and there is another reason for the low h&h.

or due to blood loss and inflamation--would her h &h have dropped?

why do h&h levels drop? check a lab reference on this. (lab tests online
http://www.labtestsonline.org/
) after reading about ulcerative colitis, especially someone who may have had the condition for awhile, you will find the connection to the low h&h levels for this case scenario.

the question i need to answer is why the sudden drop in her h & h?

if this was a sudden drop in her h&h then there is missing assessment or history information that you have not provided here.

for information on hypotonic, isotonic and hypertonic dehydration and fluid replacement, see https://allnurses.com/general-nursing-student/need-help-hyper-252786.html

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