Fluid In Nursing

M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last

The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per minute it was observed as being fast and it appeared that her accessory muscles were being used. Mrs Smith’s pallor also appeared flushed and her saturations were documented as 93%. The nurse used the stethoscope to check for wheeze the patient’s lungs were clear and chest rise was symmetrical. Mrs Smith was commenced on 100% oxygen through a non-rebreathe mask, oxygen as an intervention is necessary as Creed & Spiers (2010) highlight ‘metabolic demand for oxygen throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is maximized’ .The nurse monitored the patient closely because in her confused state the patient may try to remove the oxygen mask.

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

In the first step of the Tanner (2006) model nurses use their personal knowledge and experience to notice whether the patient requires attentions based on their expectations and looking at environment of the patient. Therefore, for an experience nurse it is easier for them responding to the similar situation if she or he revisit because the knowledge is already there through experience. In the case of Mr Devi, assessment will perform using systematic assessment based on the ABCDE approach (Airway, Breathing, circulation, Disability and Exposure). The ABCDE approach is an evidence-based practice widely accepted and used by all the members of a multidisciplinary team (MDT) to assess an acutely ill patient (Harrison and Daly 2011). First, life-threatening

and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of

2. The medical director makes rounds and writes orders to start an IV of D51/2 NS at 75 m/hr

Through the kidneys in the form of urine, evaporation in the lungs, by diffusion and perspiration in the skin, and through intestines in the form of feces.21. What conditions occur when blood pH rise and fall below 7.4? Acidemia22. Very slow shallow breathing can lead to a condition called _bradypnea___________?23. Breathing too rapidly can cause __Tachypnea_____________________.24. Excessive vomiting can lead to ___dehydration_____________.25. Prolonged diarrhea can cause ___abnormal high fluid loss in the body __________.26. What are some important factors in maintaining electrolyte balance? Consume adequate amounts of water daily, eat potassium rich foods like bananas, consume sports drinks when working out since they generally contain electrolytes, and have a balanced diet.27. Unless otherwise directed, take all medication with ___water____________ on an empty stomach to maintain the full rate of absorption.28. A patient comes in with all the signs of jaundice. You order a urine test. What elevated components are expected to be discovered from the urine test. Higher levels of urobilinogen.29. What percentage intracellular fluid does the human body contain? 62.5%30. A pint of donated blood decreases

The learning objective to be addressed in this essay is to be more adept at filling out a fluid balance chart and understand its importance. I intend to use the Driscoll (2007) reflective cycle as I find the root process of interrogating and assessing events the most helpful at being reflective. The fluid and electrolyte balance monitoring and management are essential and highly significant to nursing care as highlighted by Jevon and Ewens (2007). Patients suffering from a negative fluid balance is understood as suffering in dehydration according to the definition of dehydration by Jevon (2010) Some symptoms of dehydration, as described by Goertz (2006) include thirst, headaches, dry skin, weight loss, fatigue and pyrexia. From this point onward

BP 166/73 | Pulse 69 | Temp 96.9 °F (oral) | Resp 14 | SpO2 99% on room air

Shallow breathing and pain altered this patient’s comfort. Therefore, one of the nursing diagnoses can be stated as “Breathing Pattern, Ineffective r/t pain and anxiety, as evidenced by respiratory depth changes" (Ackley & Ladwig p. 175). We briefly discussed the specifics of incentive spirometry use before initiating the intervention. After return demonstration, the patient was ready to use his incentive spirometer.

Pt.’s with NG tubes loose potassium through suctioning. Sodium of 140 is normal but on the higher end which is indicative of dehydration. Chloride of 92 is a little low which is interesting because the sodium is normal-high and usually chloride follows sodium. Mag of 1.4 is low maybe because of low calcium.

I stayed close to the patient during this whole period, but I was not paying enough attention to her low oxygen level. The patient was a healthcare aid and she kept telling me that, “It’s ok, I am always a shallow breather”. However, I should have my own judgement ability and provide more competent care with timely evaluation of the effectiveness of the interventions.

Nursing interventions are focused on nursing behaviors to guide the patient in the direction of the most preferred outcome (Johnson et al., 2012). Fluid management, fluid/electrolyte management, and hypervolemia management are the major interventions in effective management of CHF. Fluid management is the most difficult intervention for all patients suffering from CHF. Evaluation of the patient’s ability to make the appropriate lifestyle changes required to

Monitoring of intake and output in order to identify and evaluating the negative balance that is more output than input as evidence of pulmonary crackles, distended bilateral jugular vein and decrease breath sound

This is especially important on those patients admitted with low mortality risk DRGs. This is accomplished by identifying and preventing, potentially avoidable complications and adverse events. For example, patients admitted for syncope and collapse secondary to dehydration will more than likely be placed on IV Fluids. One goal would be to hydrate the patient and reevaluate them throughout their hospitalization for improvement. However, if the patient’s intake and output is not monitored closely, the patient can become volume overloaded and develop symptoms similar to those seen with Right Sided Heart Failure. Once that happens, the patient will require additional medications and additional hospital days because of provider error of not placing an order for the Nurses to monitor his/her volume status.