Chapter 29, Problem 1CS

(1)

Summary Introduction

To determine:

The main medical problem of M.S. at this time.

Case summary:

Mr M.S., is 85-years-old engineer (retired), who seems confused His daughter takes him to department of emergency. His blood pressure is 90/62 mm Hg, his pulse rate (heart rate) is 114 beats/min and skin appears dry but cool. His daughter states that he seems weaker than normal and unable to answer properly. She also adds on that her father has lost his appetite recently and he has not taken (eaten) much food or drink. The staff nurse starts an intravenous infusion of sodium chloride (NS) at 100 mL per hour through a gravity drip infusion.

(2)

Summary Introduction

To determine:

What the staff nurse will do first and what she will watch for at this time?

Case summary:

Mr M.S., is 85-years-old engineer (retired) who seems confused. His daughter takes him to department of emergency. His blood pressure is 90/62 mm Hg, his pulse rate (heart rate) is 114 beats/min and skin appear dry but cool. His daughter states that he seems weaker than normal and unable to answer properly. She also adds on that her father has lost his appetite recently and he has not taken (eaten) much food or drink. The staff nurse starts an intravenous infusion of sodium chloride (NS) at 100 mL per hour through a gravity drip infusion.

The emergency department is fully occupied. The staff nurse returns after one hour and she is shocked to see that the whole 500 mL infusion of NS has infused completely within that time.

(3)

Summary Introduction

To determine:

Which indicator will be considered most reliable by the nurse while monitoring M.S. fluid status?

Case summary:

Mr M.S., is 85-years-old engineer (retired) who seems confused. His daughter takes him to department of emergency. His blood pressure is 90/62 mm Hg, his pulse rate (heart rate) is 114 beats/min and skin appear dry but cool. His daughter states that he seems weaker than normal and unable to answer properly. She also adds on that her father has lost his appetite recently and he has not taken (eaten) much food or drink. The staff nurse starts an intravenous infusion of sodium chloride (NS) at 100 mL per hour through a gravity drip infusion.

24 hours after his admission, the patient seems less confused and able to move easily. He is receiving 5% dextrose, ½ sodium chloride (NS) with 20 mEq of potassium chloride with a rate of 75 mL/hour through an infusion pump. M.S’ daughter notices that the region above the infusion site is red, and M.S. complains that the region or area is “very sore”.

(4)

Summary Introduction

To determine:

What is the possible problem with the intravenous (IV) line and what needs to be done at this time?

Case summary:

Mr M.S., is 85-years-old engineer (retired) who seems confused. His daughter takes him to department of emergency. His blood pressure is 90/62 mm Hg, his pulse rate (heart rate) is 114 beats/min and skin appear dry but cool. His daughter states that he seems weaker than normal and unable to answer properly. She also adds on that her father has lost his appetite recently and he has not taken (eaten) much food or drink. The staff nurse starts an intravenous infusion of sodium chloride (NS) at 100 mL per hour through a gravity drip infusion.

24 hours after his admission, the patient seems less confused and able to move easily. He is receiving 5% dextrose, ½ sodium chloride (NS) with 20 mEq of potassium chloride with a rate of 75 mL/hour through an infusion pump. M.S’ daughter notices that the region above the infusion site is red, and M.S. complains that the region or area is “very sore”.