Question

A 80 year old patient is hospitalized for vomiting and diarrhea that developed 2 days prior to admission. The patients home medications include furosemide. Current vital signs are temperature 100.9, sinus tachycardia at127 bpm, blood pressure 100/57, respirations 24 per min, regular and non-labored. A Foley catheter is placed and returns with 110 mL of dark amber urine over the last 5 hours. Tenting of skin is noted when pinched over the sternum. Patient mucous membranes are dry with deep furrows in the tongue.

1. Identify two nursing diagnoses and priority nursing interventions for this patient. Nursing interventions should be independent when possible.

2. Discuss whether these lab values will be high, normal or decreased and why?( urine specific gravity, urine volume, serum sodium, HCT, Hgb, BUN, serum osmolality).

Answer 1

1) answer :

• Fluid volume deficit related to vomitings and diarrhea as evidenced by dry lips .
• Altered temperature related to disease process as evidenced by checking of temperature with thermometer reveals 100.9 degree ' f .

Nursing interventions :

• As a health care providers ,We need to assess the patient disease condition .
• Administer the intravenous fluid if the patient not able to take fluid orally .
• Provide cold compress to patient to decrease the temperature .
• Administer the medication as per physician orders in order to reduce the patient suffering and improve the healtg status of patient .
• For diarrhea and vomitings , provide ORS solution to regain the peripheral perfusion and to maintain hydration status .
• In above question patient is catheterized , so ask the patient when she was catheterized , if it is more than 7 days it can lead to infection .
• Maintain intake and output chart .
• monitor the urin output to rule out other diseases .

2) answer :

Urin specific gravity may increased during when solutes in urine more , commonly in dehydration ,vomitings , UTI s , glycosuria etc .

Urine volume decreased

Serum sodium levels also increased in dehydration , diarrhea and vomitings ,infection etc .

Elevated hematocrit levels are also associated with dehydration , diarrhea etc.

Hemoglobin levels are also high in low volume , if the person is overloaded with fluid , the hgb and HCT both are decreased .

Blood urea nitrogen levels are also elevated .BUN done to see whether the persons kidneys are working properly ,if kidneys not able to remove the urea can lead to elevated BUN levels , most commonly seen in diarrhea, heart failure and kidney failure.

Serum osmolarity can be elevated in this condition .elevated serum osmolarity can trigger the anti diuretic hormone can lead to retention of more fluid in our body .