Strategies for Assessing and Addressing a Patient’s Fluid Balance and Requirements

The nurse is caring for a patient who weighs 75 kg. The patient has intravenous (IV) fluids infusing at a rate of 50 mL/hour and has consumed 100 mL of fluids orally in the past 24 hours. Which action will the nurse take?a. Contact the provider to ask about increasing the IV rate to 90 mL/hour.b. Discuss with the provider the need to increase the IV rate to 150 mL/hour.c. Encourage the patient to drink more water so the IV can be discontinued.d. Instruct the patient to drink 250 mL of water every 8 hours.

To determine the appropriate action to take, the nurse needs to consider the patient’s fluid balance and requirements

To determine the appropriate action to take, the nurse needs to consider the patient’s fluid balance and requirements.

First, let’s calculate the patient’s fluid intake in the past 24 hours:

IV fluids infusing at a rate of 50 mL/hr × 24 hours = 1200 mL
Oral fluid intake = 100 mL
Total fluid intake = 1200 mL + 100 mL = 1300 mL

Next, let’s assess the patient’s fluid output or losses. This includes urine output, feces, and any other measurable fluid losses. If the nurse knows the total fluid output, it should be subtracted from the total fluid intake to calculate the patient’s fluid balance. If the nurse does not have access to this information, she should assess the patient for signs and symptoms of dehydration, such as decreased urine output, dry mouth, thirst, or changes in mental status.

The nurse should also consider the patient’s individual fluid requirements. This depends on various factors, including the patient’s weight, age, underlying condition, and any ongoing losses.

Given the information provided, there is no mention of the patient’s fluid output or losses. However, assuming a normal fluid balance, the total fluid intake of 1300 mL may not be sufficient for a patient weighing 75 kg.

Option a: Contacting the provider to ask about increasing the IV rate to 90 mL/hour is not appropriate because the current rate of 50 mL/hr is already higher than the oral fluid intake. Increasing it to 90 mL/hr may lead to fluid overload unless there are signs and symptoms of dehydration or increased fluid losses.

Option b: Discussing with the provider the need to increase the IV rate to 150 mL/hour may be excessive without further information about the patient’s fluid balance and requirements.

Option c: Encouraging the patient to drink more water so the IV can be discontinued is not appropriate without assessing the patient’s fluid balance and ensuring that oral intake meets the patient’s needs.

Option d: Instructing the patient to drink 250 mL of water every 8 hours is a reasonable initial action. This would total to 750 mL over 24 hours. Adding the oral intake to the current IV fluid rate of 50 mL/hr (1200 mL + 100 mL + 750 mL), the patient’s total fluid intake would be 2050 mL, which may be more appropriate for the patient’s weight.

Therefore, the most appropriate action for the nurse to take based on the information provided would be d. Instruct the patient to drink 250 mL of water every 8 hours. However, it is important to continue monitoring the patient’s fluid balance and reassess if necessary, involving the healthcare provider as needed.

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