Urinary Disorders Q 58

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Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs over the past two years. She is fatigued from lack of sleep, has lost weight, and urinates frequently even in the night. Her labs show: sodium, 154 mEq/L; osmolarity 340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis is a priority?

  

    A. Fluid volume deficit related to osmotic diuresis induced by hyponatremia

    B. Fluid volume deficit related to inability to conserve water

    C. Altered nutrition: Less than body requirements related to hypermetabolic state

    D. Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency

    

    

Correct Answer: B. Fluid volume deficit related to inability to conserve water

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Monitor and document vital signs especially BP and HR. Decrease in circulating blood volume can cause hypotension and tachycardia. Alteration in HR is a compensatory mechanism to maintain cardiac output. Usually, the pulse is weak and may be irregular if electrolyte imbalance also occurs. Hypotension is evident in hypovolemia.

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Option A: The serum sodium result is normal. Assess skin turgor and oral mucous membranes for signs of dehydration. Signs of dehydration are also detected through the skin. Skin of elderly patients loses elasticity, hence skin turgor should be assessed over the sternum or on the inner thighs. Longitudinal furrows may be noted along the tongue.

Option C: Identify the possible cause of the fluid disturbance or imbalance. Establishing a database of history aids accurate and individualized care for each patient. Weigh daily with the same scale, and preferably at the same time of day. Weight is the best assessment data for possible fluid volume imbalance. An increase of 2 lbs a week is considered normal.

Option D: Monitor serum electrolytes and urine osmolality, and report abnormal values. Elevated blood urea nitrogen suggests fluid deficit. Urine specific gravity is likewise increased. Note the presence of nausea, vomiting, and fever. These factors influence intake, fluid needs, and route of replacement.

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