Fluids and Electrolytes Case Study

F&E case study:

Fluids and Electrolytes Case Study

A 68 year-old alcoholic is admitted with medical diagnoses of cirrhosis of the liver, atrial fibrillation, and hypertension. At home he has been on a low Na+ diet and he takes digoxin 0.125 mg daily.

1. Initial assessment: (explain each, including appropriate pathophysiology; may list this section only in bullet format and then explain adequately) – obvious ascites with 3+ peripheral edema – VS: 108/66 lying, 82/48 standing; 116 and regular but weak; 32 and shallow – breath sounds clear but diminished all lobes – hypoactive bowel sounds x 4 – urine voided shortly after admission: 80 mL, very concentrated, specific gravity 1.048 – he demonstrates alternating drowsiness and confusion and is c/o cramping in the lower extremities – at one point during the assessment, he looks at you and comments “Oh, my dear, you look just like an angel.” – Admitting labs: H&H, Na+ , and BUN all elevated; K+ 2.7; total protein 5.0, albumin 2.8; digoxin level 0.6 ng/mL.

2. This patient has experienced a fluid shift. Explain: fluid compartment(s) involved?? direction of fluid movement?? Cause of such in his case?? Include appropriate pathophysiology.

3. MDs orders: (explain each, including the goal of each therapy) – 1000 ml D5NS with 30 mEq KCl at 125 ml/hr – Albumin 25% 100 mL now (1 bottle) and again at 0600 the next morning – Furosemide 80 mg IVP Describe appropriate assessments by the nurse during each therapy above.

4. He continues to receive D5NS with KCl during the evening and night shifts and demonstrates marked improvement. However, the night nurse reports that the ordered 0600 albumin infused “ahead of schedule” and your initial assessment reveals: -BP 180/110, pulse 120 and bounding -Extreme dyspnea with crackles throughout both lung fields to mid-scapular area -Engorged neck veins at 90 degrees What has occurred and why?? What would you as the RN do immediately and what MDs orders would you anticipate?? Explain rationale for EACH.