Unfolding Case Study
a, c, e
Rationale: Normal Saline (0.9% sodium chloride) causes hyperchloremia and metabolic acidosis, which may move potassium from the intracellular space into the interstitial fluid and plasma. Normal saline is a cornerstone of intravenous solutions commonly used in the clinical setting. It is a crystalloid fluid that hydrates and improves electrolyte disturbances. The primary indications for the use of normal saline infusion that have been approved by the FDA:
- extracellular fluid replacement (e.g., dehydration, hypovolemia, hemorrhage, sepsis)
- mild sodium depletion
Administration of antiemetic will limit the nausea and vomiting and further loss of fluids. Administration of pain medication needs observation for hypotension. If the patient has pain with a BP < 89/49, the provider needs to be notified for an alternate pain medication.
There is no need to have a CXR, as there is no fluid buildup, lungs are clear, and there is no SOB. The need for ABG at this point is not necessary for treatment options. Ketorolac can be administered, separately, but close in time to the hydromorphone. There is no contraindication and the patient should not go long periods of time without both the NSAID and analgesic.
a, d, e
Rationale: The patient is eating regular food without N/V. The surgeon will send the patient home with oral ondansetron if needed. The patient’s K+ level has returned to normal range and is asymptomatic of signs/symptoms of an elevated K+. The patient’s pain has been moderately managed. The patient was educated to expect pain will not be a 0–1 level and will continue with increased activity and PT. Also to continue the same meds po for pain and inflammation as she was. The patient was also educated to not go more than 4–6 hours at the most without taking her pain and anti-inflammatory medication ordered by the provider. The pain will then become harder to manage and may not be as effective because of the length of time going without medication.
The patient chemistries do not reflect a metabolic acidosis. The patient’s oxygenations and kidney function are normal. The patient has feen afebrile with a normal WBC and no signs of infection. Multiple organ dysfunction syndrome involves dysfunction of two organs and extreme decreased tissue perfusion and oxygenation. Cardiac status and VS are within the patient’s baseline.