The Importance of Continuing Intravenous Fluids and Frequent Patient Reassessment in the Treatment of Dehydration: An Analysis of Serum Electrolyte Levels and Urine Output

A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/hour. The nurse assuming care for the patient reviews the patient’s serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?a. Contact the patient’s provider to discuss increasing the potassium chloride to 40 mEq/L.b. Continue the intravenous fluids as ordered and reassess the patient frequently.c. Notify the provider and discuss increasing the rate of fluids to 200 mL/hour.d. Stop the intravenous fluids and notify the provider of the assessment findings.

Based on the patient’s current situation, the most appropriate action for the nurse to take is option b: Continue the intravenous fluids as ordered and reassess the patient frequently

Based on the patient’s current situation, the most appropriate action for the nurse to take is option b: Continue the intravenous fluids as ordered and reassess the patient frequently.

Let’s analyze the patient’s situation and the rationale behind this response:

1. Fluid prescription: The patient is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride. This fluid combination is commonly used to treat dehydration and can help replenish both water and electrolyte levels in the body.

2. Serum electrolyte levels: The patient’s serum sodium level is 140 mEq/L, which falls within the normal range of 135-145 mEq/L. Therefore, there is no immediate concern regarding serum sodium levels.

3. Serum potassium level: The patient’s serum potassium level is 3.6 mEq/L, which is slightly on the lower side of the normal range of 3.5-5.0 mEq/L. However, it is not severely low enough to require an immediate increase in potassium chloride concentration or rate of administration.

4. Urine output: The patient’s urine output of 250 mL in the last 12 hours indicates that the kidneys are functioning to some extent, although the output is on the lower side. This can be a reflection of dehydration, and the intravenous fluids are being given to address this.

Considering these factors, the nurse can continue the intravenous fluids as ordered and monitor the patient closely. Reassessing the patient frequently will help determine if there are any changes in the serum electrolyte levels or urine output. The nurse should also assess the patient’s overall condition, vital signs, and clinical manifestations of dehydration, such as dry mucous membranes, decreased skin turgor, and altered mental status.

It is important to note that any significant changes or worsening of the patient’s condition should be communicated to the provider promptly. The nurse should closely follow the orders provided by the healthcare provider and adhere to the established monitoring schedule.

In summary, the nurse should continue the intravenous fluids as ordered and reassess the patient frequently to monitor for any changes in electrolyte levels or urine output.

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