Author Question: The nurse is caring for a 73-year-old female client who is 3 days postoperative for a bowel ... (Read 63 times)

yoooooman · **on:** Jul 23, 2018

The nurse is caring for a 73-year-old female client who is 3 days postoperative for a bowel ob-struction.

The nurse knows that the stress response of surgery causes fluid-balance changes in the second to fifth postoperative day, when aldosterone, glucocorticoids, and antidiuretic hormone (ADH) are increasingly secreted, causing sodium and chloride retention and potassium excretion. Because of this, it is important for the nurse to closely monitor:
1. Urine output
2. Intake of sodium
3. Activity level
4. Oxygen level

Question 2

A mother brings her 2-year-old daughter to the clinic with a 2-day history of a fever of unknown origin.

The mother explains to the nurse that the air conditioning in her apartment is not working and it has been very hot; her daughter has been vomiting for 2 days and has had a fever, and the child is lethargic. The child's rectal temperature is 101.1 F. The nurse knows the child is probably de-hydrated and should do which of the following first?
1. Give the child some juice to drink.
2. Prepare to start an IV.
3. Get an order for an antipyretic.
4. Sponge the child to bring down the fever.

xthemafja · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: 1
Recent surgery is a condition that places clients at high risk for fluid, electrolyte, and acid-base alterations. Clients continue to be at risk during the acute phase until the underlying process is resolved. For example, the stress response of surgery causes fluid-balance changes in the second to fifth postoperative day, when aldosterone, glucocorticoids, and ADH are increasingly secret-ed, causing sodium and chloride retention, potassium excretion, and decreased urinary output. The client's diet most likely has not advanced enough to be concerned about excess sodium in-take. The client's activity level is important, and the nurse should encourage her to increase her activity level. The client's oxygen level is also important to monitor, but has no direct effect on the fluid, electrolyte, and acid-base alterations

Answer to Question 2

ANS: 2
Children ages 2 through 12 have less stable regulatory responses to imbalance, and in childhood illnesses they tend to operate within a more narrow range with less tolerance for severe fluid and electrolyte imbalance. Clients who have been exposed to temperature extremes may have clinical signs of fluid and electrolyte alterations. Exposure to environmental temperatures exceeding 28 to 30 C (82.4 to 86 F) results in excessive sweating with weight loss. A body weight loss over 7 decreases the ability of the cooling mechanism to conserve water. The nurse's first priority is fluid volume replacement, then an antipyretic (because the fever is not dangerously high). If the child has been vomiting, she is likely to vomit the juice.