Runninghead:FLUID AND ELECTROLYTES CASE STUDY

Fluid and Electrolytes Case Study

Van Mai
Kapiolani Community College
Fall 2015
1. Describe the basic components of heart failure.
Heart failure occurs when the heart loses its ability to pump blood effectively. Normally
the ejection fraction of the heart is 60-80%. In a patient with heart failure, ejection fraction is
below 60%. It is usually a result of myocardial cells dysfunction, infraction, thickening of the
ventricular wall or enlargement of the heart due to coronary diseases or chronic hypertension.
Heart failure could be either systolic or diastolic dysfunction or both. It could also be left-side
heart failure or right-side heart failure or both. Left-side heart failure is commonly a result of
thickening of the ventricular wall due to hypertension. As a result, ventricles fail to relax during
diastolic leading to ineffectively filling cause low ejection fraction. Right-side heart failure is
often a result of left-side heart failure. (Copstead, 409 - 413)
2. What do you think was occurring at the elementary school where she volunteered that resulted
in her vomiting and diarrhea? Cite the mode of transmission.
Several students were vomiting and sent home a few days prior to when Mrs. Malone got
sick. Therefore, Malones symptoms could possibly from a viral gastroenteritis. Viral
gastroenteritis is an inflammation of the gastric lining in the stomach and or intestines from

FLUID AND ELECTROLYTES CASE STUDY

infected with virus. The virus can be easily transmitted from person to person through close
contact or by contact with infected surfaces or object (Beckett&Bright,2013).
3. Using your own words, describe the mechanisms that occur with orthostatic hypotension.
Include the effect of blood pressure and heart rate.
Orthostatic hypotension is a drop of systolic pressure of 20mm Hg when a person
changes their posture from lying to sitting or standing. When a person changes a body posture
from lying to sitting or standing, about 700mm of blood remains in the lower legs and abdominal
area, which results in a decrease of blood pressure. In a healthy person, SNS kicks in to
compensate to prevent hypotension by increasing vascular resistance, heart rate, and cardiac
output and venous return. However, in a person with inadequate intravascular volume (ECF
deficit) or their health is compromised, the body is unable to compensate. As a result, a systolic
pressure drop of 20mm Hg causes light headache, blurred vision, and dizziness. (Shibao, Lipsitz
& Biaggioni, 2013)
4. What electrolyte imbalance was occurring when Mrs. Malone began to drink more water?
Keep in mind that her diarrhea persisted and dietary intake was reduced during this time.
Hypotonic occurred. Mrs. Malone lost a lot of fluid and electrolytes, especially sodium
due to persisted vomiting and diarrhea. She needed to increase water and electrolytes intake to
replace the loss. However, she only increased tap water intake and didnt increase dietary intake
of sodium. As a result, her osmolality reduce cause water to enter the cells, making cells swell
and eventually lose functions if the condition is not corrected (Copstead, 524-525). In addition,
when she vomiting, she loses intestinal acid, which causes metabolic alkalosis. Diarrhea also
causes HCO3 loss, which leads to metabolic acidosis. As a result, she also has potassium
imbalance (Gennari&Weise,2008)
5. What electrolyte imbalance was occurring when Mrs. Malone stopped taking her KCL? Were
there other factors contributing to this electrolyte imbalance?

FLUID AND ELECTROLYTES CASE STUDY

Hypokalemia occurred when she stopped taking KCl due to her cardiac disease. Losing
potassium through vomiting and diarrhea, and reducing dietary intake and diuretic therapy are
also contributing to this electrolyte imbalance.
6. Why did the NP recommend Mrs. Malone drink broth with salt and orange juice?
Mrs. Malone increases output of fluid and electrolytes via vomiting and diarrhea. The NP
recommends her to drink broth with salt and orange juice to help restore fluid and electrolytes
loss. Orange juice contains a pretty high amount of potassium and other electrolytes.
7. What is the relationship between Mrs. Malones electrolyte imbalance and weak legs?
What other recommendations should have been made at this time by the nurse?
Mrs. Malone is at risk for fall. Losing fluid and electrolytes through vomiting and
diarrhea and failure to replace fluids and electrolytes caused hypokalemia, hyponatremia and
fluid volume deficit (hypovolemia). Thus, she may be experiencing muscle weakness and cardiac
and respiratory change, orthostatic hypotension and confusion, and nausea and abdominal
cramps. The nurse should advise patient to practice fall prevention when ambulating, changing
posture, standing or walking. The nurse should access patients blood pressure, gait stability,
muscle strength, cardiac and respiratory functions, alertness and home environment. The nurse
should recommend patient ensures adequate lighting and a safe environment at home (remove
hazard, obstacles, slippery areas). In addition, educate patient about the use of ambulating
assistive devices such a cane or walker, and encourage a family member to stay and assist
patient, and that restoring fluids and electrolytes are necessary interventions for patients safety
(Ignatavicius & Workman, 175-176, 186).
8. As the nurse consultant, what time frame would you want her electrolytes to be rechecked?
It would take Mrs. Malone about 3 days to get better. She will be advised to go to an out
patient clinic to recheck if her symptoms are not reduced and get worst.
9. Are there any other health care providers that should be considered in planning care for Mrs.
Malone? Site a minimum of four and their role in her care. Research and reflect thoroughly
about this collaboration.

FLUID AND ELECTROLYTES CASE STUDY

The nurse could collaborate with these health care providers in planning care for Mrs.
Malone:
1. A nutritionist will help planning an appropriate diet to restore Mrs. Malones fluid and
electrolytes balances and educate her about fluid and electrolyte balance.
2. A primary care physician who supervise and direct care for Mrs. Malone.
3. Home health nurse to assist with care need and support during illness because she
doesnt have support
4. Social worker to help her with obtaining social and financial assistance and planning
for future course.
10. Describe Medicare and provisions that fund Mrs. Malone in accessing primary care.
Medicare provision part B will cover medical cares and services that prevent illness and
injury. This provision will allow Mrs. Malone to access the primary care provider, as well as any
health care specialists she may needed. Medicare also offers low co-payment plans for her
medications.
11. If Mrs. Malone were eligible for home care, what five objective data would the RN ask the
health care team to make?
The RN could delegate these tasks to a CNA:
Take vital signs and notify any abnormality
Obtain height and weight
Measure and record patients input and output
Obtain a stool specimen
Assisting clients with bathing, ambulating, eating as needed and review overall
home safety. (Smith, 53)
12. If Mrs. Malone had refused to restart her KCl, what ethical principle would she be
asserting? Does Mrs. Malone have the right to refuse this treatment?
Mrs. Malone is asserting autonomy. She has the right to refuse this treatment. It is an
ethical dilemma for healthcare personnel because refusing taking KCl potentially poses a danger
to her health condition. The healthcare personnel can explain the risks of stopping to take KCl to
the patient but must respect and apply her final decision. (Cherry, 174)

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13. Consider and cite two to three cultural implications in caring for an elderly AfricanAmerican woman.
It is very important for nurses to assess an African American elders skin appropriately
due to her skin color to detect abnormal tone changes for conditions such as cyanosis and
dehydration (Giddens, 252)
Also, many African Americans are lactose intolerant. Advise Mrs. Malone not to
consume any food that contains dairy products. (Ignatavicius & Workman, 188)
There is lack of trust in health care system in African American population. Thereis
evidenceofreluctanceinusingWesternhealthcare. About 57.4% of the time, African
Americans seek complementary and alternative medicine when they get sick (Cushman, Wade,
Kalmuss, and Chao (2006) as stated in Use of Complementary and Alternative Medicine in the
African American Culture) Therefore, nurses need to be aware of this aspect and carefully
assess patient use of over the counter herbal medicines to prevent complication of medications
interactions.

14. What have you learned completing this case study? Equally as important, what do you think
you need to know more about to be a competent nurse managing Na+ and K+ imbalances?
Completing this case study, I learned the importance of fluid and electrolytes balance,
what causes the imbalance, and how to manage and restore fluid and electrolytes imbalance. The
case study also reinforces my nursing ethical practice, nursing delegation, and Medicare
coverage knowledge. In addition, I learned about cultural competence in caring for the African
American population. Finally, I think I need to learn more about the causes and management of

FLUID AND ELECTROLYTES CASE STUDY

excessive fluid and electrolytes losses in order to be a competent in managing Na+ and K+
imbalances.

FLUID AND ELECTROLYTES CASE STUDY

References
Beckett,G.,&Bright,J.(2013).Preventionandcontrolofviralgastroenteritis.Nursing&
ResidentialCare,15(6),426430.
Cherry. B, Susan. J. (2014) Contemporary nursing: issues, trends, & management, 6th Edition.
Mosby. VitalBook file.
CMS.gov (n.d) Medicare program - general information. Retrieved on August 28, 2015 at
https://www.cms.gov/Medicare/Medicare-GeneralInformation/MedicareGenInfo/index.html
Copstead. K, Lee. E, Jacquelyn. B. (2014) Pathophysiology, 5th Edition. W.B. Saunders
Company. VitalBook file.
Giddens, J. (2013) Concepts for nursing practice. Mosby. VitalBook file.
Gennari,J.,Weise,W.,(2008)AcidBaseDisturbancesinGastrointestinalDiseaseCJASN(6)1861
1868;,doi:10.2215/CJN.02450508
Ignataviciuc. D, Workman. L. (2013) Medical-surgical nursing: patient centered collaborative
care. W.B. Saunders Company. VitalBook file.
Revell, M. (2012). Use of Complementary and Alternative Medicine in the African American
Culture. International Journal Of Childbirth Education, 27(3), 55-59.
Smith. S, Duel. D, Martin. B (2011). Clinical nursing skills, 8th Edition. Pearson. Kindle
Edition.
Shibao, C., Lipsitz, L. A., & Biaggioni, I. (2013). ASH position paper: evaluation and treatment
of orthostatic hypotension. Journal of Clinical Hypertension (Greenwich, Conn.), 15(3),
147-153. doi:10.1111/jch.12062