death&dying/ fluid & electrolytes

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1

The nurse is caring for John, a 70 year old patient, who has just been diagnosed with Acquired Immunodeficiency Syndrome (AIDS). He lost his job at age 64 due to downsizing. He then got depressed and started using heroin. He became an intravenous drug addict, his wife kicked him out of the house, and his family would not speak to him. He has been homeless for the last 5 years. He recently reconnected with his adult daughter. She wants to help him with his illness. He desires to be treated at home and he wants his care to focus on relief and reduction of his symptoms. His daughter wants him to have the best quality of life possible in the time he has left.

Palliative care

2

John's wife and other children have not come to visit him and have told his daughter that she should have let him die in the streets because he brought this on himself by using drugs. John's daughter is very sad about her father's situation and she is grieving without the support of her extended family. Which kind of grief does the nurse recognize that is she experiencing?

Disenfranchised

3

The patient is grieving over his illness and the lost time with his family. He is going through the stages of grief. Place the following statements made by a patient with a terminal illness in order according to Kubler-Ross's five stages of Grief in Death and Dying.

"I'm getting another opinion because I was told 3 months ago everything was fine." (Denial)

"I cannot believe the doctor missed the tumor 3 months ago when I was last examined." (Anger)

I will give up my cigars to see my grandchildren born this summer."(Bargaining)

"I will never see my grandchildren grow up and married." (depression)

"I am working on a tape recording that I'm making for my grandchildren." (acceptance)

4

The patient would like to have his wishes for his care to be written down in a legal document. John does not want to be resuscitated if his heart stops. The nurse suggests that he fills out some forms to declare his wishes. Advance Directives are based on the values of informed consent, patient autonomy, and control over the process of dying. The nurse is teaching the family about what types of documents are included in Advanced Directives. Then nurse knows that one of the following is not included in the Advanced Directive packet?

Organ donation eligibility

5

John’s daughter and son-in-law are sitting in the hospital cafeteria. The nurse makes eye contact with the daughter and attempts to make small talk, but she does not respond. The nurse recognizes that the usually talkative family member is withdrawn. Which of these is the nurse's best response?

"You are very quiet today."

6

What culturally specific rituals and mourning practices are used by Hispanic or Latino populations?

Amulets may be used.

7

The nurse is admitting a 86-year-old female with hypertension. The patient's vital signs are: 98.6 F -95- 18 & 85/45. Her daughter brought her to the Emergency Department because she has become increasingly weak and confused. The daughter tells the nurse that her mother drinks very little fluids and takes a "water pill" for her blood pressure 2 or 3 times a day. The label on the medication bottle that she brought to the hospital states, hydrochlorothiazide (Microzide), take 1 tablet daily. This patient is admitted with fluid volume deficit. The nurse explains that the body naturally tries to keep the fluid in balance and that the patient is showing an imbalance of not enough fluid.

For ongoing evaluation of this patient's fluid volume status, it is most important for the nurse to obtain which assessment data?

Body weight

8

The patient's daughter reports that her mother usually weighs approximately 150 pounds and is 5 ft. 4 inches in height. The nurse weighs the patient and obtains a weight of 59 kilograms.

The nurse explains that the weight loss represents approximately how many liters of fluid has been lost?

9 L

9

The nurse is reading the healthcare provider's (HCP) progress notes in the patient's record and reads that the HCP has documented a "insensible fluid loss of approximately 400 mL in 24 hours." The nurse knows that this type of fluid loss occurred when the patient experienced which process?

Respiration

10

In preparation to evaluate the patient's laboratory values, the nurse reviews values that reflect fluid and electrolyte changes with another nurse. The nurse is correct when making the following statements. (Select all that apply)

"Cations are positively charged."

Hypernatremia will produce a serum osmolality level of 350 mmol/kg."

"The patient has hyponatremia if their serum Na level is 130mEq/L."

11

The nurse starts an intravenous line to administer fluids. The order states "5% normal saline (NS) to infuse at 100 mL/hr." The client's most recent serum sodium level is 134 mEq/L. What action should the nurse take?

Consult with the health care provider about the order

12

The nurse also observes that the patient's feet and ankles are swollen. When the nurse presses a finger over the client's ankles (bony prominence), a 4 mm indentation appears.

This finding by the nurse is a result of fluid increasing in which fluid compartment?

Interstitial

13

The nurse completes a medication reconciliation and notes that the patient is prescribed additional medications that effect her electrolytes. The medications include furosemide (Lasix), fluoxetine (Prozac), captopril (Capoten), and her husband was giving her ibuprofen (Advil) regularly for the last few days. The nurse identifies which of the following electrolytes as being effected by most by these medications?

Potassium and sodium

14

In completing the medication reconciliation, the nurse has identified that the patient's serum potassium is at a high risk for being imbalanced. The nurse knows that serious problems can develop when fluid, electrolyte, and acid imbalances occur. Which clinical finding will the nurse identify to correlate with potassium imbalance?

Irregular balance

15

The nurse continues to monitor the IV that is infusing at 250 mL/hr. After 5 hours, the nurse notices that the patient's intake and output measurements indicate her intake is greater than her output. The nurse is concerned that she may develop fluid volume excess. Which assessment is important for the nurse to perform?

Auscultate the client's breath sounds