NURS 102: Fluid and Electrolytes

“Who wants to be sick today?” Game

Instructions:

Choose a volunteer, ask, “Who wants to be sick today?” Once you have a volunteer ask them, “How much do you trust your classmates?” This is because they will be relying on their classmates to save them.

The volunteer must then draw a sickness (related to fluid and electrolytes) out of the box and read their S&S to the class. The class must diagnose them, and decide what nursing interventions to implement in order to get their classmate feeling better before the “exam”. The class will have ten minutes to have a representative from each table to write as many nursing interventions on the board as they can. When the ten minutes is up, the class must stop writing interventions.

The instructor will then discuss the interventions written on the board. If the intervention is appropriate for their sick classmate, the sick classmate gets one point. If the intervention is not appropriate, the sick classmate gets one point deducted. To ensure that the sick classmate is feeling better before the exam, the class must have accumulated at least 10 points (at least10 appropriate nursing interventions). If they failed to get at least 10 points, the class did not save their sick classmate in time.

Sickness 1:

You got food poisoning from bad sushi that you bought from a gas station. You have had nausea, vomiting and diarrhea x3 days. Subsequently, you have not been able to eat or drink anything in three days. You decide to come into the ER and you were diagnosed with severe dehydration. Your S&S include: Extreme thirst despite being able to drink anything, nausea, vomiting, diarrhea, weight loss, metabolic alkalosis, hypovolemia, tachycardia, postural hypotension, hypokalemia, and hyponatremia.

Suggested nursing interventions:

  • Start a peripheral IV and administer IV fluids (hypotonic solution such as ½ NS ).
  • Administer an antiemetic to relieve nausea.
  • Administer an antidiarrheal to relieve diarrhea symptoms.
  • Replace electrolytes by administering them preferably IV due to nausea symptoms.
  • Instruct patient to remain in bed and change positions slowly to reduce effects of postural hypotension.
  • Continue to monitor lab values- electrolytes
  • Encourage fluids when patient is able to tolerate them.
  • Educate the patient on the importance of staying hydrated when N/V/D occur.
  • Assess the S&S of dehydration and metabolic acidosis.
  • Continually assess IV site for signs of infiltration or phlebitis.

Sickness 2:

You are a 45 year old male who has a history of drug abuse and has been subsequently diagnosed with congestive heart failure. You come to the ER with a chief complaint of difficulty breathing. The assessment findings are as follows: 3+ pitting edema in the extremities, crackles in the lung bases, pulmonary congestion, weight gain, increased BP and hypernatremia.

Suggested nursing interventions:

  • Sit patient up bed to allow for easier breathing.
  • Respiratory assessment.
  • Administer O2 as prescribed.
  • Restrict fluid and sodium intake.
  • Administer a diuretic such as Lasix or furosemide
  • Monitor electrolytes especially K+ after administration
  • Daily weights to monitor fluid balance.
  • Educate the client on importance of a heart healthy diet and restricting sodium intake.
  • Elevate the extremities on pillows to reduce swelling.
  • Continually assess for S&S of FVE (fluid volume excess).Which are?

Sickness 3:

You are a nursing student and you are extremely stressed out about exams. On your way to class you get stuck in heavy traffic and you are late to class. You discover upon arrival that you are locked out and you are missing out on important lecture material on a topic that you are struggling with. You begin to hyperventilate and pass out. A classmate finds you in the hallway and calls 911. Upon arrival to the ER, you regain consciousness but have another panic attack when you realize where you are because you cannot afford an ER bill or to miss anymore classes. You begin to cry and hyperventilate again. You are found to be in Respiratory alkalosis, your lab values also reveal that you are hypokalemic and now you feel your fingers and toes tingling.

Suggested nursing interventions:

  • Have patient breath into a paper bag or place a nonrebreather mask on them.
  • Educate them on different coping mechanisms for stress.
  • Monitor electrolytes and replace potassium as prescribed.
  • Insert a peripheral IV for fluid resuscitation and medications if necessary.
  • Administer an anxiety medication as ordered if needed.
  • Monitor for S&S of respiratory alkalosis and continue to monitor ABG values.
  • Monitor Electrolytes.
  • Stay with the client until the anxiety/ panic attack subsides.
  • Inquire as to what is causing the anxiety.
  • Refer client to a psychologist if necessary.

Sickness 4:

You were in an automobile accident and suffered severe trauma and blood loss. Upon arrival to the hospital, you are found to be hypovolemic and your hemoglobin is 6.2. You are actively bleeding from your right leg.

Suggested nursing interventions:

  • Insert a large bore peripheral IV (at least a 20 gauge) in anticipation of administering blood/blood products.
  • Prepare toadminister fluids compatible with blood or products (isotonic solution of 0.9% sodium chloride).
  • Prepare Y tubing for blood products.
  • Apply pressure on the wound that is actively bleeding.
  • Assess for S&S of hypovolemia. What are they?
  • Monitor electrolytes.
  • Monitor H&H lab values.
  • Monitor IV site for sings of inflammation and phlebitis.
  • Monitor patient after administration of blood or blood products for a transfusion reaction.
  • Educate patient.

Sickness 5:

You have been admitted to the telemetry unit at a hospital. You were dehydrated and hypotensive upon arrival so the MD ordered your fluids to be bloused. The nurse comes in to assess you during the bolus infusion and finds you to be in circulatory overload or FVE. Your S&S include, crackles in the lung bases and dyspnea.

Suggested nursing interventions:

  • Contact the physician
  • Slow the infusion rate.
  • Elevate the head of the client’s bed.
  • Respiratory assessment.
  • Monitor electrolytes and daily weights.
  • Apply O2 as prescribed.
  • Monitor for S&S of FVE. What are they?
  • Educate the client on the condition and interventions.
  • Acknowledge that bolus infusions have the potential to cause life threatening changes such as this and monitor closely.
  • Limit fluid intake.

Sickness 6:

You are a 37 year old female with a history of alcoholism and liver cirrhosis. You have been in the hospital for a couple of days and you are now experiencing alcohol withdrawal symptoms and have now developed a fluid and electrolyte imbalance. You have an enlargement of your abdomen (ascites) that is full of fluid. You are confused and agitated.

  • Note and assess the presence of third spacing in the abdomen.
  • Monitor electrolyte imbalances (especially magnesium in the case of an alcoholic).
  • Daily weights.
  • Insert peripheral IV and monitor site.
  • Educate client on the effects of alcoholism.
  • Monitor for S&S of withdrawal and electrolyte imbalances.
  • Reorient patient as needed.
  • Monitor LFT’s.