Central Line Case study
The patient is a 45 year old man who had GI surgery 4 days ago. He is NPO, has a nasogastric tube, and IV fluids of D51/2saline at 100 mL/hr. The nursing physical assessment includes the following: alert and oriented; fine crackles; capillary refill within normal limits; moving all extremities, complaining of abdominal pain, muscle aches, and "cottony" mouth; dry mucous membranes, bowel sounds hypoactive, last BM four days ago; skin turgor is poor; 200 mL of dark green substance has drained from NG tube in last 3 hours. Voiding dark amber urine without difficulty. Intake for last 24 hours is 2500mL. Output is 2000mL including urine and NG drainage. Febrile and diaphoretic; BP 130/80; pulse 88; urine specific gravity 1.035; serum potassium 3.0 mEq/l; serum sodium 140mEq/l, CL 92mEq/l, Mg 1.4 mg/dL.
1.) Analyze the data in the case study. Do the findings indicate a fluid deficit or fluid excess problem? Support your answer with data from this patient.
I would guess a fluid volume deficit. Dark amber urine, dry mucus membranes, poor skin turgor, and labs all point in that direction. Although the patient’s output seems to be adequate, everything else points towards dehydration. It also seems like the patient has a fluid/electrolyte imbalance which may be putting the water in the wrong departments, or an infection (as reflected in pt. vital signs). So even though he is receiving IV fluids, it’s not reflecting on his physical assessment and labs.
2.) What factors could be contributing to this problem?
Part of the problem may be that most of the patient’s fluids are being received via IV (2400ml in 24 hours) and has only drunk 100ml PO in the past 24 hours. Low GI motility because of recent GI surgery may have something to do with it, or a f/e imbalance, or an infection could be a contributing issue. Lastly fever and diaphoresis can cause high amounts of insensible fluid loss.
3.) Evaluate the patient's electrolyte values and give a rationale for the
1.) Analyze the data in the case study. Do the findings indicate a fluid deficit or fluid excess problem? Support your answer with data from this patient.
I would guess a fluid volume deficit. Dark amber urine, dry mucus membranes, poor skin turgor, and labs all point in that direction. Although the patient’s output seems to be adequate, everything else points towards dehydration. It also seems like the patient has a fluid/electrolyte imbalance which may be putting the water in the wrong departments, or an infection (as reflected in pt. vital signs). So even though he is receiving IV fluids, it’s not reflecting on his physical assessment and labs.
2.) What factors could be contributing to this problem?
Part of the problem may be that most of the patient’s fluids are being received via IV (2400ml in 24 hours) and has only drunk 100ml PO in the past 24 hours. Low GI motility because of recent GI surgery may have something to do with it, or a f/e imbalance, or an infection could be a contributing issue. Lastly fever and diaphoresis can cause high amounts of insensible fluid loss.
3.) Evaluate the patient's electrolyte values and give a rationale for the