CASE STUDY #1
A 55 year old female with lung cancer was ad/mitted to your unit. She c/o increasing
fatigue, SOB with activity, and decreased ability to perform mental functions. She has been
drinking more fluids in response to increased thirst but is not urinating as much. She has
gained over 5 lbs the past week despite decreased appetite and abdominal cramping. Lab
values show: K+ 3.5, Na+
126, Cl- 90, serum osmolality 260 mOsm/L, and urine osmolality 450 mOsm/L.
1. What do you suspect is going on with this client?
I believe this client has SIADH resulting in hypervolemia and hyponatremia.
2. Underline the signs and symptoms associated with this condition.
Increased thirst but is not urinating as much, SOB with activity, and decreased ability to perform
mental functions, 5 + lbs weight gain, decreased appetite and abdominal cramping.
3. If untreated, what additional signs and symptoms would you expect to see?
I would expect to see neuro s/s: headache, convulsions, coma Nausea, vomiting Fluid overload:
increased BP & CVP, possible CHF, pulmonary edema.
4. What treatment modalities would you expect the physician to consider?
I would expect to see the goal would be to restore normal fluid volume and osmolality which may
include: fluid restriction; if needed, hypertonic saline IV, diuretic (furosemide with K+
replacement or urea).
5. What are your primary nursing responsibilities to this client?
1. Safety
2. Anticipate, assess and intervene appropriately
3. Patient teaching: drugs, fluid restrictions, electrolyte replacements
CASE STUDY #2
A 65 year old female is admitted to your unit complaining of nausea, vomiting and diarrhea
for 3 days. Her history is unremarkable except hypertension for which she takes
hydrochlorothiazide. She relates feeling exhausted and having leg cramps which interfere
with her sleeping. Notable assessment findings include T. 38.6 C, AP 102 and irregular, B.P.
90/50; absent bowel tones, poor muscle tone and skin turgor.
Laboratory data includes
□K+ 2.9 mEq/L,
□Na+ 137 mEq/L
□Cl- 97 mEq/L
□WBC 20,000/ul.
ECG shows cardiac arrhythmias (frequent PVCs)
This study source was downloaded by 100000829818949 from CourseHero.com on 04-17-2022 07:14:35 GMT -05:00
https://www.coursehero.com/file/29312867/Fluid-and-Electrolyte-Case-Studiesdocx/
, Physician's orders include:
□ IV D50.9%NaCl with 20 mEq KCl/L to infuse at 90cc/hr.
□40 mEq of KCl IV over the next 2 hours
□K+ level 30 minutes after 40 mEq IV KCl has infused
□Bedrest: May use bathroom
□NPO
1. What fluid and/or electrolyte disturbances does this client have?
Hypokalemia & Hypovolemia
2. Which electrolyte disturbance is of most concern with this client?
Hypokalemia
3. Underline the signs and symptoms that can result from this electrolyte disturbance.
Their exhausted, leg cramps, AP 102 and irregular, absent bowel tones, poor muscle tone and
skin turgor.
4. What do you suspect as the cause(s) of this electrolyte disturbance?
Vomiting, K+ wasting diuretic therapy, and no K+ replacement
5. What type of solution is D5NS with 20mEq KCl/L?
Hypertonic
6. Would you question any of these orders? Why?
Yes. Hypertonic IV solution when hypovolemia is isotonic; too much K+ to be administered over
2 hours; does not specify how much fluid to dilute K+ in.
7. List safe administer principles for IV potassium
check drug information/books prior to administration for complete information)
Never give IV push!!!
dilute with appropriate amount of recommended fluid
don't give IV K+ >10- 20meq/hr. Or >30-40meq/L
add K+ to nonhanging contained & invert well to mix;
assess IV site frequently: peripheral prone to irritation/chemical phlebitis so may need
ice bag, mild sedation, or slower rate (check with Dr.);
continuous cardiac monitor if >10-20meq/hr.
assess for hyperkalemia s/s with IV K+ administration & immediately notify Dr. if
present
Over the next several days the patient receives antibiotics (Vancomycin). The diuretic is
changed to Spironolactone and she continues to receive the same maintenance IV plus 40
mEq po potassium daily. Her nausea, vomiting, leg cramps, and irregular heart rate
resolved. Temp and BP are now within normal limits. However, for the past 24 hours, her
urine output has been declining and is currently at <20 cc./hr. The patient now c/o
abdominal cramping, numbness/tingling sensations in her extremities. She is irritable and
has been experiencing diarrhea. In addition she has developed some pulse slowing and
irregularity.
This study source was downloaded by 100000829818949 from CourseHero.com on 04-17-2022 07:14:35 GMT -05:00
https://www.coursehero.com/file/29312867/Fluid-and-Electrolyte-Case-Studiesdocx/
A 55 year old female with lung cancer was ad/mitted to your unit. She c/o increasing
fatigue, SOB with activity, and decreased ability to perform mental functions. She has been
drinking more fluids in response to increased thirst but is not urinating as much. She has
gained over 5 lbs the past week despite decreased appetite and abdominal cramping. Lab
values show: K+ 3.5, Na+
126, Cl- 90, serum osmolality 260 mOsm/L, and urine osmolality 450 mOsm/L.
1. What do you suspect is going on with this client?
I believe this client has SIADH resulting in hypervolemia and hyponatremia.
2. Underline the signs and symptoms associated with this condition.
Increased thirst but is not urinating as much, SOB with activity, and decreased ability to perform
mental functions, 5 + lbs weight gain, decreased appetite and abdominal cramping.
3. If untreated, what additional signs and symptoms would you expect to see?
I would expect to see neuro s/s: headache, convulsions, coma Nausea, vomiting Fluid overload:
increased BP & CVP, possible CHF, pulmonary edema.
4. What treatment modalities would you expect the physician to consider?
I would expect to see the goal would be to restore normal fluid volume and osmolality which may
include: fluid restriction; if needed, hypertonic saline IV, diuretic (furosemide with K+
replacement or urea).
5. What are your primary nursing responsibilities to this client?
1. Safety
2. Anticipate, assess and intervene appropriately
3. Patient teaching: drugs, fluid restrictions, electrolyte replacements
CASE STUDY #2
A 65 year old female is admitted to your unit complaining of nausea, vomiting and diarrhea
for 3 days. Her history is unremarkable except hypertension for which she takes
hydrochlorothiazide. She relates feeling exhausted and having leg cramps which interfere
with her sleeping. Notable assessment findings include T. 38.6 C, AP 102 and irregular, B.P.
90/50; absent bowel tones, poor muscle tone and skin turgor.
Laboratory data includes
□K+ 2.9 mEq/L,
□Na+ 137 mEq/L
□Cl- 97 mEq/L
□WBC 20,000/ul.
ECG shows cardiac arrhythmias (frequent PVCs)
This study source was downloaded by 100000829818949 from CourseHero.com on 04-17-2022 07:14:35 GMT -05:00
https://www.coursehero.com/file/29312867/Fluid-and-Electrolyte-Case-Studiesdocx/
, Physician's orders include:
□ IV D50.9%NaCl with 20 mEq KCl/L to infuse at 90cc/hr.
□40 mEq of KCl IV over the next 2 hours
□K+ level 30 minutes after 40 mEq IV KCl has infused
□Bedrest: May use bathroom
□NPO
1. What fluid and/or electrolyte disturbances does this client have?
Hypokalemia & Hypovolemia
2. Which electrolyte disturbance is of most concern with this client?
Hypokalemia
3. Underline the signs and symptoms that can result from this electrolyte disturbance.
Their exhausted, leg cramps, AP 102 and irregular, absent bowel tones, poor muscle tone and
skin turgor.
4. What do you suspect as the cause(s) of this electrolyte disturbance?
Vomiting, K+ wasting diuretic therapy, and no K+ replacement
5. What type of solution is D5NS with 20mEq KCl/L?
Hypertonic
6. Would you question any of these orders? Why?
Yes. Hypertonic IV solution when hypovolemia is isotonic; too much K+ to be administered over
2 hours; does not specify how much fluid to dilute K+ in.
7. List safe administer principles for IV potassium
check drug information/books prior to administration for complete information)
Never give IV push!!!
dilute with appropriate amount of recommended fluid
don't give IV K+ >10- 20meq/hr. Or >30-40meq/L
add K+ to nonhanging contained & invert well to mix;
assess IV site frequently: peripheral prone to irritation/chemical phlebitis so may need
ice bag, mild sedation, or slower rate (check with Dr.);
continuous cardiac monitor if >10-20meq/hr.
assess for hyperkalemia s/s with IV K+ administration & immediately notify Dr. if
present
Over the next several days the patient receives antibiotics (Vancomycin). The diuretic is
changed to Spironolactone and she continues to receive the same maintenance IV plus 40
mEq po potassium daily. Her nausea, vomiting, leg cramps, and irregular heart rate
resolved. Temp and BP are now within normal limits. However, for the past 24 hours, her
urine output has been declining and is currently at <20 cc./hr. The patient now c/o
abdominal cramping, numbness/tingling sensations in her extremities. She is irritable and
has been experiencing diarrhea. In addition she has developed some pulse slowing and
irregularity.
This study source was downloaded by 100000829818949 from CourseHero.com on 04-17-2022 07:14:35 GMT -05:00
https://www.coursehero.com/file/29312867/Fluid-and-Electrolyte-Case-Studiesdocx/
