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Hyponatremia & Fluid Volume Excess Case Study

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Hyponatremia & Fluid Volume Excess Case Study
MJ is a 68-year-old female with a history of heart failure, hypertension, and diabetes. She is admitted to the ED with
complaints of shortness of breath at rest and weight gain of 5 pounds. MJ and her daughter acknowledge non-compliance
with her low sodium (2G) diet and fluid restriction. MJ reports compliance with her medication regimen. Her medications
currently include: lisinopril 20 mg daily, furosemide 40 mg daily, and K-dur 20 mg daily.
Physical Assessment
Vital Signs: T: 37.6 C, BP 160/84; Apical Pulse 102 and irregular; RR 28. Pulse oximetry 87%.
Notable assessment findings include:
- Neuro: Patient is agitated, restless, mild headache reported. Verbal response to questions is delayed.
- CV: Pulses 4+, + S3, + JVD, ECG WNL
- Respiratory: Lung auscultation reveals bilateral basilar crackles. Mild intercostal retractions.
- GI: Mild nausea and anorexia reported. Bowel sounds hyperactive in all 4 quadrants. Denies diarrhea.
- Skin: Cool to touch. 3+ pretibial edema.
- GU: Urine yellow, clear, output WNL.
Metabolic Chem Panel
Sodium
130
135 -145 mEq/L
Potassium
3.8
3.5 5.0 mEq/L
Calcium
9.0
8.6 `10.0 mEq/L
Magnesium
2.0
1.8 2.4 mEq/L
BUN
5.0
6.0 20.0 mg/dL
Creatinine
1.0
0.6 1.2 mg/dL
Glucose
88
70-100 mg/dL
Osmolality
270
275-295 mOsm/kg
Urine specific gravity
1.004
1.010-1.025
Complete Blood Count
WBC
7.6
4-10 / ul
Hemoglobin
9.8
11.7 16 g/dL
Hematocrit
32%
37%-48%
Platelet
356,000
150,000 450,000ul
Arterial Blood Gas
pH
7.47
7.35-7.45
PaCO2
32
35-45 mmHg
HCO3
21
22-26 mEq/L
PaO2
75
80-100 mmHg
What laboratory data reflect changes in volume?
Hyponatremia: What are your nursing considerations based on this abnormal lab finding?
Lab Value
Sodium
Value
130
High/Low
Low
Contributing
Factors
(cause)
- Heart failure.
Too much
sodium and
fluid.
- Weight gain
SOB
- Delayed
verbal
response
- Mild
headache
- elevated BP,
apical pulse
102 and
irregular,
resp: 28,
Potential
Complications
-Cerebral
edema
-Tissue
hypoxia
-Pulmonary
edema
- Decreased
ability to
oxygenate the
body.
Nursing Assessment
What are the clinical findings reflecting
FVD and hyponatremia?
Neuro: Patient is restless and agitated,
mild headache reported. Verbal
response to questions is delayed.
-CV: Pulses 4+, positive S3, positive
JVD, ECG is within normal limits.
-Respiratory: Lung auscultation
reveals bilateral basilar crackles. Upon
inspection noted mild intercostal
retractions.
-GI: C/O nausea and anorexia. Bowel
sounds hyperactive in all 4 quadrants.
No episodes of diarrhea.
-Skin: Cool to touch. 3+ pretibial
edema.
Interventions/Treatment
Elevate the head of the bed
Give O2 as ordered
Give loop diuretics
Fluid restriction
Sodium restriction
Monitor patient’s response to
therapy
Evaluate patient’s mental status,
breathing, and oxygen levels
looking for improvement.
Monitor serum sodium levels.

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Pulse OX
87%.
-GU: Urine yellow, clear, output within
normal limits.

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Hyponatremia & Fluid Volume Excess Case Study MJ is a 68-year-old female with a history of heart failure, hypertension, and diabetes. She is admitted to the ED with complaints of shortness of breath at rest and weight gain of 5 pounds. MJ and her daughter acknowledge non-compliance with her low sodium (2G) diet and fluid restriction. MJ reports compliance with her medication regimen. Her medications currently include: lisinopril 20 mg daily, furosemide 40 mg daily, and K-dur 20 mg daily. Physical Assessment Vital Signs: T: 37.6 C, BP 160/84; Apical Pulse 102 and irregular; RR 28. Pulse oximetry 87%. Notable assessment findings include: - Neuro: Patient is agitated, restless, mild headache reported. Verbal response to questions is delayed. - CV: Pulses 4+, + S3, + JVD, ECG WNL - Respiratory: Lung auscultation reveals bilateral basilar crackles. Mild intercostal retractions. - GI: Mild nausea and anorexia reported. Bowel sounds hyperactive in all 4 quadrants. Denies diarrhea. - Skin: Cool to touch. 3+ pretibial edema. - GU: Urine yellow, clear, output WNL. Metabolic Chem Panel Sodium Potassium Calcium Magnesium BUN Creatinine Glucose Osmolality Urine specific gravity Complete Blood Count WBC Hemoglobin Hematocrit Platelet 130 3.8 9.0 2.0 5.0 1.0 88 135 -145 mEq/L 3.5 – 5.0 mEq/L 8.6 – `10.0 mEq/L 1.8 – 2.4 mEq/L 6.0 – 20.0 mg/dL 0.6 – 1.2 mg/dL 70-100 mg/dL 270 1.004 275-295 mOsm/kg 1.010-1.025 7.6 9.8 32% 356,000 Arterial Blood Gas pH PaCO2 HCO3 PaO2 7.47 32 2 ...
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