Impairments, Fluid/Electrolytes, Elimination

Written Assignment #4 – 35 pts

Instructions: Complete the following questions independently of your peers. Be concise yet detailed. You may use bulleted answers. Save this document as Assignment4Your name

Submission: Email completed assignment to

J. L. is brought to the hospital emergency room by some friends. He had been vomiting for several days and was complaining of heart palpitations. J. L. is a 58-year-old white male who is homeless. He has not had any health care for at least 10 years. He is an alcoholic and drinks a quart of gin or vodka every day. He does not have a job, and his family is all out of state. The emergency physician does an initial assessment and transfers him to a hospitalist, who admits him to a medical-surgical unit for further evaluation and treatment. Mr. Lewis has lab work drawn. His electrolytes are as follows: sodium 138 mEq/L, potassium 3.1 mEq/L, chloride 104 mEq/L, and magnesium 1.5 mEq/L. His arterial blood gas measurements are as follows: pH 7.48, PaCO2, 40 mm Hg, HCO3 29.

  1. (3 pts)What electrolyte imbalances does J.L. have? What fluid imbalance does he have? Why?
  1. (2pts) What acid/base imbalance is J.L. experiencing and why?
  1. (2 pts) What type of IV fluids would the nurse expect the hospitalist to order? Give a specific example of this type of fluid.
  1. (2 pts) What interventions are appropriate for J.L.’s electrolyte imbalances?
  1. (3pts) Despite IV fluids, J.L. has not had a bowel movement since admission 3 days ago. It is unknown when his last bowel movement was. What assessment findings would indicate this is constipation instead of fecal impaction?
  1. (15pts) Throughout this course you have had to complete a partial care plan. Now make your own. Pick a priority diagnosis and list 2 interventions and outcomes for this patient. (remember POCI)
  • ______R/T ______AMB______
  • Interventions
  • The nurse will….
  • The nurse will….
  • Outcomes
  • The patient will…
  • The patient will….
  • What happens if an outcome is not achieved by the evaluation date?
  1. (3 pts) J.L. is being discharged today. Review the scenario and nursing problems. What teaching does he need?
  1. (1 pt) A client has impaired vision. An intervention to best adapt the environment to this loss includes:
  2. Putting the side rails up on the bed
  3. Maintaining the same schedule every day
  4. Keeping the room pathways free of clutter
  5. Assisting the client with ambulation
  1. (1 pt) A client taking lasix (furosemide) for congestive heart failure is seeing the physician for a potassium value of 3.0. An order for oral potassium taken daily is written and discussed with the client. In addition, potassium-rich foods should be eaten. The nurse educator meets with this client and has the client identify all of the following foods as potassium-rich except:
  2. Baked potato
  3. White bread
  4. Apricot
  5. Orange juice
  1. (1 pt) An elderly patient was hydrated with lactated Ringer's solution in the emergency room for the last hour. During the most recent evaluation of the patient by the nurse, a finding of a rapid bounding pulse and shortness of breath were noted. Reporting this episode to the physician, the nurse suspects that the patient now shows signs of:
  2. Hypovolemia, and needs more fluids
  3. Hypervolemia, and needs the fluids adjusted
  4. An acid-base disturbance
  5. Needing no adjustment in fluid administration
  1. (1 pt) The nurse is admitting a new client, 80 years old, with congestive heart failure into your home health agency. The following assessment findings have been determined after meeting the client: overweight but no gain since the client left the hospital two days ago; VS: T 99.0, HR 100, R 22, BP 130/86. Foods eaten include canned soup at each meal, ham, and cheese. When completing the care plan for this client, the nurse should include which of the following nursing diagnosis:
  2. Improved Gas Exchange
  3. Risk for Fluid Volume Imbalance
  4. Knowledge deficit
  5. Impaired Skin Integrity
  1. (1 pt) An 80-year-old client is in the emergency department. The client complains of diarrhea and vomiting for the past two days. In assessing the client, it is noted that his skin is dry and can be tented, he has lost eight pounds, and is itchy. Which NANDA diagnosis would be most appropriate to use with this client in making his plan of care?
  2. Risk for Deficient fluid volume related to prolonged diarrhea and vomiting
  3. Risk for fluid volume excess related to prolonged diarrhea and vomiting
  4. Risk for normal fluid volume related to prolonged diarrhea and vomiting
  5. Risk for hidden fluid related to prolonged diarrhea and vomiting