Case Study 2
As a senior student you are assigned to work with a preceptor in the emergency department. It is a remarkably busy day, & it seems as if every patient, regardless of chief complaint, has an issue with fluid, electrolyte, and or acid-base balance.
The first patient you see is a thirty-seven-year-old landscaper who is brought to the ED after collapsing on a job at the local country club. He is slightly confused but can tell you he feels dizzy & weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. The nurse identifies a nursing diagnosis of deficient fluid volume.
1. Describe how each of the following would change and the rationale for the change in the presence of deficient fluid volume
| Parameter | Expected Change | Rationale |
| Heart rate
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| Blood pressure
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| Serum hematocrit
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| Urinary output
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| Urine specific gravity
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| Weight
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- What is usually the first indicator that an individual needs more fluids?
- The ED physician orders IV fluids for this patient. What types of fluids are indicated for a fluid volume deficit due to dehydration?
The preceptor tells you to go ahead & initiate an IV site and start the fluids. The fluid order is to start 1000 mL of fluid as ordered at 150 mL/hr. The infusion tubing has a drop factor of 15 gtt/mL.
- This infusion will run by gravity rather than an infusion pump. How many drops per minute should you time the infusion at to ensure the correct hourly rate? (See Chapter 22 in “Calculate with Confidence)
- The patient has a “full sleeve” tattoo on both arms. Discuss the implications of this finding and how you will initiate the intravenous site.
- You have difficulty finding a vein in the presence of the deficient fluid volume. What strategies can you employ to help make a vein more visible/palpable?
- After 30 minutes of the infusion, the patient states, “My arm where the needle is feels funny.” What should you do first? What further data do you need from the patient?
Several hours later the patient is feeling better & is now oriented x 3. The ED physician wants the patient to be drinking oral fluids without difficulty prior to being discharged from the ED.
- Discuss the strategies to increase fluid intake that are most appropriate to this setting.
- The patient is discharged after adequate hydration. Discharge teaching includes ways to prevent this from happening again on the job. What key points should the nurse include in the teaching applicable to the job site?
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