Mrs. M.B. was admitted to room 103. She is a 98 year old female, a client of Dr. Mandeep. She was admitted on March 11 after steadily declining at home. She is weak, tired, more confused, and suffers from back pain. She was diagnosed with hyponatremia. Mrs. M.B. is a DNR. She is allergic to Chloromycetin, Darvon, Influencze virus vaccine, Penicillins, Sulfa, and Tetracyclines.
Hyponatremia
Hyponatremia is a deficit of sodium in the body (Gould & Dyer, 2011, p. 125). This can result from loss of sodium-containing fluids, water excess, or a combination of the two (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011, p.313). One of the common causes of hyponatremia is the inappropriate use of sodium-free or hypotonic IV fluids (Lewis, 2011, p.313). This situation can occur after surgery, major trauma, or with administration of fluids with renal failure patients (Lewis, 2011, p.313). Other common causes include excessive sweating, vomiting, and diarrhea; use of diuretic drugs; insufficient aldosterone, adrenal insufficiency, and excess antidiuretic hormone (ADH) secretion; early chronic renal failure; or excessive water intake (Gould & Dyer, 2011, p. 125).
The first effects of hyponatremia will be manifested in the central nervous system (CNS). The extra amount of water will lower the plasma osmolality, causing the fluid to shift into the brain cells (Lewis, 2011, p.313). This fluid shift will cause irritability, apprehension, confusion, seizures, and possibly a coma (Lewis, 2011, p.313). Severe and untreated hyponatremia can cause irreversible neurologic damage or death (Lewis, 2011, p.313). The clinical manifestations include anorexia, nausea, cramps, fatigue, lethargy, muscle weakness, headache, confusion, seizur...
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... drastic changes may be fatal for patients that are unable to compensate for the sudden increased blood return to the heart (Lewis, 2011, p. 1012).
When caring for a patient with constipation a nurse should monitor for lethargy, hemorrhoids, abscesses, abdominal distention, hypoactive bowel sounds, fecal impaction, and hard stools with blood (Lewis, 2011, p. 1012). Many cases of constipation can be treated with proper dietary fiber, fluid, and exercise (Lewis, 2011, p. 1012). Stool softeners such as milk of magnesia and suppositories may also be used to prevent constipation (Lewis, 2011, p. 1012). Patient teaching should include the importance of activity, adequate fiber intake, and proper hydration needs (Lewis, 2011, p. 1012). Exercise will promote GI movement; fiber and hydration will keep the stool from becoming hard and impacted (Lewis, 2011, p. 1012).
Vital to maintenance of homeostasis is the regulation of plasma osmolality. The Renin-Angiotensin-Aldosterone system, which works to regulate blood pressure, plays a crucial role in fluid balance. When dehydration occurs, blood osmolality increases, which stimulates the release of antidiuretic hormone (ADH), ultimately leading to increased water reabsorption. This leads to more concentrated urine, and less concentrated plasma. Low plasma osmolality works in the opposite fashion: ADH release is inhibited, water reabsorption decreases, and urine is less concentrated. The added electrolytes and carbohydrates in Gatorade would facilitate greater fluid retention through stimulation of renin and vasopressin, increasing urinary sodium reabsorption (3). Studies of both urine volume and plasma volume changes are eff...
The SMART goal for the patient’s diagnosis of diarrhea is that the patient will defecate formed, soft stool every 1 to 3 days and will express relief of cramping with little or no diarrhea. The intervention to meet this smart goal is the administration of fidaxomicin, a narrow spectrum antibiotic, to treat the infection of Clostridium difficile (Sears, 2013). Another nursing intervention for the treatment of diarrhea is assessing the patient for sodium and potassium loss, as well as explaining the prevention methods to avoid the spread of excessive diarrhea (Mitchell, 2014). The nurse must also provide proper skin integrity care to the peritoneal are and make the environment safe and easy for access to the bathroom. The SMART goal for the patient’s diagnosis of acute pain is that the patient will state relief of pain in abdominal area after treatment with opioids in a 24hr period. The nursing intervention for acute pain is the administration of opioids as well as positioning to keep patient in as much comfort as possible and take pressure off of the abdominal area. The nurse must also assess the patient’s vital signs and pain level
This also caused an increase in demand of oxygen to the cardiac muscle so it’s not a good thing (Ignatavicius &Workman, 2013, p. 747).
Hypovolemia is the decreased of blood volume related to extracellular fluid volume insufficiency. Extracellular volume is determined by the total amount of sodium and water when osmolality is normal. Visible loss of sodium, chloride and total body water due to increased fluid loss such as diarrhea, vomiting and polyuria or inadequate fluid intake is called actual hypovolemia. When the water within the body is displaced not lost, from the intravascular space to the interstitial space, it is called relative hypovolemia. (Ignatavicius & Workman,
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
When diagnosed with hyponatremia treatment usually immediately begins. Treatment must be a restriction of both salt and water (Gheorghita et. al 2010). Hyponatremic patients must receive a slow increase in sodium with a restriction of liquids. Intravenous hypertonic saline solution of 3% NaCl can be administered to patients who have been diagnosed with hyponatremia. There is a precise formula that is used in determining the quantity of NaCl that is used in increasing sodemia and the rate at which it should be administered (Gheorghita et. al 2010).
When there is an increased concentration of sodium ions in the blood, certain areas in the brain such as the hypothalamus and the pituitary gland gives information for release of ADH, “an anti - diuretic hormone” which in turn trigger the kidneys to “reabsorb more water to rehydrate the body” (olchs.org). This is an example of osmosis since water is the substance moving being reabsorbed into the body system to a low concentration which is the blood through various semi permeable membranes such as glomerulus and the red blood cells.
Symptoms are not usually present in mild chronic hyponatremia, as is seen with this patient. Symptoms are more likely when there is a rapid decrease in serum sodium levels and when sodium is < 120 mEq/mL. In asymptomatic SIADH, fluid restriction will restore the serum sodium to normal. Treatment of the small cell carcinoma with chemotherapy should give a permanent end to the source of the ADH. Restriction to 50% to 60% of daily fluid requirements may be required to achieve the goal of inducing negative water balance. In general, fluid intake should be less than 800
Mrs. A is a 71-year-old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother 's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:
There are several causes to elderly dehydration, which can be broken down into four groups: physiological factors, psychological factors, functional impairments, and mechanical impairments. (Hamilton, 2001) The physiological factors are: natural 10% body fluid loss, diminish of taste making food less appetizing and adding salt for flavor, thirst diminishes, medications that are diuretics or laxatives, and draining wounds. (Hamilton 2001) The caffeine in coffee and soda, the theophylline in tea, and the throbromine in cocoa, all raise blood pressure along with increase production and elimination of urine. (Vasey, 2002) Alcohol, on the other hand, dries out the mucous membrane causing sclerosis. (Vasey, 2002) Diarrhea, vomiting, or febrile illness also contributes to elderly dehydration. (Moore, 2005) The psychological factors are: depression which contributes to loss of appetite, purposefully decrease fluid to reduce bathroom trips. (Hamilton, 2001) The functional impairments are: coma, paralysis and N.P.O (Nothing Per Orem) patients. (Hamilton, 2001) Elderly individuals with disabilities such as: visual, cognitive or motor impairment may need assists with water intake. (Kavanaugh, 2000) Tubal feeding may need additional water in the nutr...
Dehydration is a condition where an individual uses or loses more fluids than taken in and the body does not have enough fluids to carry out normal functions. Some distinct features of dehydration include dry mucous membranes, decreased urine output, extreme thirst, and dark colored urine. Though anyone can be affected by dehydration, it is most commonly seen in infants and children. These two age groups have a higher prevalence of dehydration compared to other age groups. This is because total body water is found to be the highest in infants and children ranging from 73% to 85%, compared with 58% in adults (Hockenberry & Wilson, 2013). The high percentage of total body fluid predisposes infants and children to a rapid loss of fluids and consequently, causing dehydration. Additionally, those with weaker immune systems and chronic illnesses, such as the very young and very old, are more likely to develop dehydration and suffer from serious complications. More than two million infants and children are affected by dehydration in the United States, while approximately thirty
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
Patient profile: Heterosexual Muslim Woman who has been in the United Stated for three years. She came from Pakistan. She is 42 forty-two years old, from low socioeconomic standing, English language barrier, and is Muslim rituals and practices. She came to emergency department with her husband due to shortness of breathing, high fever, severe cough. She was dignosed with new onset of pneumonia and currently on antibiotic. she also has history of Vitamin D deficiencies and diabetes mellitus type II. She admitted to medical-surgical floor for observation...
Rationale: Early signs of dehydration include thirst and cessation of perspiration, muscle cramps, nausea and vomiting, lightheadedness, and orthostatic hypotension. Ackley and Ladwig p. 345
The patient has also been suffering from frequent fevers in the past two months. He has also suffered from frequent headaches but has always taken painkillers (Bloland & Williams, 2003, p. 58). On fevers, the patient has frequently visited a local health clinic that has never done any diagnosis but has given medication, which reduces the fever.