A 32-year-old female patient is showing signs of moderate dehydration and electrolyte imbalance, with vital signs indicating potential hypovolemic shock. Her lab results show hyponatremia and hypokalemia. What is the nurse's priority intervention?

A) Administer an isotonic IV fluid with added electrolytes

B) Apply oxygen via nasal cannula to improve oxygenation

C) Initiate a calorie-dense nutritional supplement via oral intake

D) Prepare the patient for immediate dialysis to address renal impairment

A 32-year-old female patient is showing signs of worsening dehydration and electrolyte imbalance despite initial rehydration efforts. Her vital signs include blood pressure 90/55 mmHg, heart rate 115 bpm, respiratory rate 24 breaths per minute, and temperature 102.1°F. Lab results indicate hyponatremia and hypokalemia. Which of the following interventions should the nurse prioritize to stabilize the patient’s hemodynamic status?

A) Administering isotonic intravenous fluids and monitoring vital signs frequently

B) Initiating broad-spectrum antibiotics to address potential infection

C) Applying cooling measures to reduce the patient's fever

D) Encouraging oral intake of clear fluids to promote hydration

A patient with hyponatremia and hypokalemia has developed abdominal pain, distension, and decreased bowel sounds after receiving a balanced electrolyte solution intravenously. An abdominal X-ray shows bowel distension without obstruction, indicating paralytic ileus. What nursing intervention is most appropriate to address the patient's condition?

C) Insert a nasogastric tube for gastrointestinal decompression.

A) Increase IV fluid rate to promote electrolyte balance.

B) Administer an antiemetic to reduce nausea and vomiting.

C) Insert a nasogastric tube for gastrointestinal decompression.

D) Encourage oral intake of fluids to improve hydration.

A patient with hyponatremia and hypokalemia develops abdominal distension and decreased bowel sounds after receiving intravenous electrolyte replacement. An abdominal X-ray confirms paralytic ileus. What is the nurse's priority intervention in managing this patient?

B) Initiate nasogastric decompression to relieve the symptoms of paralytic ileus.

A) Increase the rate of intravenous fluid administration to further improve electrolyte levels.

B) Initiate nasogastric decompression to relieve the symptoms of paralytic ileus.

C) Administer additional potassium supplements to correct the hypokalemia.

D) Prepare the patient for immediate surgical intervention to resolve the ileus.

A patient with suspected paralytic ileus has developed an elevated heart rate, increased respiratory rate, fever, and elevated white blood cell count with neutrophilia. The healthcare team has initiated broad-spectrum antibiotic therapy. What is the nurse's priority action in managing this patient's care?

A) Monitor the patient for signs of antibiotic hypersensitivity reactions.

B) Increase the frequency of vital signs monitoring to every 2 hours.

C) Prepare the patient for immediate surgical intervention.

D) Discontinue the patient's potassium supplementation immediately.

A patient with evolving gastrointestinal dysfunction and evidence of an inflammatory process is being considered for an escalation in antibiotic therapy. Which nursing action is most important to prioritize to prevent complications associated with the patient’s current condition?

B) Administer potassium supplements as ordered and monitor serum levels.

A) Monitor the patient's abdominal girth every 8 hours.

B) Administer potassium supplements as ordered and monitor serum levels.

C) Encourage increased oral fluid intake to prevent dehydration.

D) Position the patient in a semi-Fowler's position to enhance comfort.

A patient with worsening abdominal pain localized to the right lower quadrant, increased tenderness, guarding, hypoactive bowel sounds, and elevated C-reactive protein is being evaluated. A CT scan reveals wall thickening and edema in the terminal ileum. Considering these findings, what is the priority nursing intervention?

C) Monitor the patient closely for signs of perforation or sepsis

A) Encourage the patient to ambulate to stimulate bowel activity

B) Administer prescribed potassium supplements to correct hypokalemia

C) Monitor the patient closely for signs of perforation or sepsis

D) Prepare the patient for immediate surgical intervention

A patient with suspected sepsis is experiencing increased heart rate, decreased blood pressure, and reduced urine output. Which of the following nursing interventions is most appropriate to address the patient's current hemodynamic status?

B) Initiate intravenous fluid resuscitation to improve perfusion.

A) Administer oral rehydration solutions to improve fluid balance.

B) Initiate intravenous fluid resuscitation to improve perfusion.

C) Increase the patient's dietary intake to enhance energy levels.

D) Encourage ambulation to promote circulatory function.

A patient is being monitored for signs of hemodynamic instability and potential infection. Despite treatment, the patient’s condition worsens with an increased heart rate, decreased blood pressure, and elevated white blood cell count. As a nurse, what is the most appropriate initial intervention to address the suspected hypovolemia and potential early tissue hypoperfusion?

B) Initiate intravenous fluid resuscitation

A) Administer broad-spectrum antibiotics

B) Initiate intravenous fluid resuscitation

D) Prepare the patient for exploratory laparotomy

gastroenteritis - Nursing Case Study

Pathophysiology

• Primary mechanism: Gastroenteritis is primarily caused by infection with viruses (e.g., norovirus, rotavirus), bacteria (e.g., E. coli, Salmonella), or parasites, which invade or irritate the gastrointestinal mucosa, leading to inflammation. This results in increased secretion of fluids into the intestines and decreased absorption, causing diarrhea.

• Secondary mechanism: The infection often induces the release of inflammatory mediators and toxins, which can disrupt the normal function of the epithelial cells lining the gut. This disruption can impair nutrient absorption and further promote fluid secretion, exacerbating dehydration and electrolyte imbalances.

• Key complication: Dehydration is a significant complication, especially in vulnerable populations like children and the elderly, as ongoing fluid loss through diarrhea and vomiting can rapidly lead to severe electrolyte disturbances and hypovolemic shock if not promptly addressed.

Patient Profile

Demographics:

32, female, school teacher

History:

• Key past medical history: Irritable Bowel Syndrome (IBS)

• Current medications: Probiotic supplement, oral contraceptive

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe abdominal pain and diarrhea

• Key symptoms: Nausea, vomiting, fever, dehydration

• Vital signs: Temperature 101.3°F, heart rate 110 bpm, blood pressure 95/60 mmHg, respiratory rate 22 breaths per minute

Section 1

Change in Patient Status:

As the medical team continues to monitor the 32-year-old female patient, her condition begins to show signs of deterioration. Despite initial rehydration efforts with intravenous fluids, her symptoms persist and even worsen. The patient now exhibits increasing lethargy and confusion, indicating a potential progression to moderate dehydration and electrolyte imbalance. Her vital signs reveal a further drop in blood pressure to 90/55 mmHg and a persistent tachycardia with a heart rate of 115 bpm. Her respiratory rate remains elevated at 24 breaths per minute, and her fever has increased to 102.1°F. These changes suggest that the patient is at risk for developing hypovolemic shock, necessitating prompt and targeted intervention.

Laboratory results return, confirming a significant decrease in serum electrolytes, with sodium at 130 mEq/L and potassium at 3.0 mEq/L, indicating hyponatremia and hypokalemia, likely due to ongoing fluid and electrolyte losses. Additionally, her blood urea nitrogen (BUN) and creatinine levels are elevated, suggesting early signs of acute kidney injury secondary to dehydration. The patient's clinical presentation and lab findings require the healthcare team to reassess and adjust her treatment plan. This includes intensifying fluid replacement, considering the addition of electrolyte-rich solutions to address imbalances, and monitoring renal function closely to prevent further complications.

Given the patient's worsening condition and the risk of complications associated with dehydration and electrolyte disturbances, the healthcare team must prioritize stabilizing her hemodynamic status. The focus will also need to be on identifying the specific causative pathogen through appropriate stool cultures and tailoring antimicrobial therapy if necessary, considering her penicillin allergy. This scenario underscores the importance of vigilant monitoring and timely intervention to prevent escalation to more severe complications, such as hypovolemic shock or significant renal impairment, and to facilitate the patient's recovery.

Section 2

As the healthcare team intensifies the patient's treatment, they decide to administer a balanced electrolyte solution intravenously to address her hyponatremia and hypokalemia more effectively. Within the next few hours, the patient's condition is closely monitored for any response to the intervention. However, her clinical status takes an unexpected turn. Despite the adjustment in her treatment plan, she begins to exhibit signs of increasing abdominal pain, accompanied by a distended abdomen and a decrease in bowel sounds. These new symptoms raise concerns about a potential secondary complication, such as paralytic ileus, which can occur due to electrolyte imbalances and dehydration.

The medical team orders an abdominal X-ray to investigate the cause of her abdominal symptoms further. The imaging reveals significant bowel distension without evidence of obstruction, supporting the suspicion of paralytic ileus. This development necessitates a reevaluation of her management plan. The team decides to place a nasogastric tube to decompress the gastrointestinal tract and prevent further complications. They also consider consulting a gastroenterologist to explore additional therapeutic options and to ensure comprehensive care.

In conjunction with these interventions, the patient's electrolyte levels and renal function continue to be monitored closely. Repeat laboratory tests show a slight improvement in her sodium levels, now at 132 mEq/L, but her potassium remains low at 3.1 mEq/L, requiring ongoing supplementation. Her BUN and creatinine have stabilized, indicating that the intensified fluid replacement is beginning to have a positive effect on her renal function. The team remains vigilant in their monitoring, aware that timely adjustments to her treatment are critical to preventing further deterioration and promoting recovery. As they address these complications, the focus will also be on determining the underlying cause of her gastroenteritis to provide targeted antimicrobial therapy if needed, all while considering her penicillin allergy.

Section 3

As the healthcare team continues to monitor the patient following the interventions for suspected paralytic ileus, they note a change in her status. Her vital signs show an elevated heart rate, now at 110 beats per minute, and a slight increase in her respiratory rate to 22 breaths per minute. Her blood pressure remains stable at 110/70 mmHg, but her temperature rises to 38.3°C (100.9°F). These changes suggest a possible inflammatory or infectious process, prompting the team to reassess her condition. The nasogastric tube placement has alleviated some abdominal distension, but her abdominal pain persists, and her bowel sounds remain faint, indicating ongoing gastrointestinal dysfunction.

In response to these new developments, the team opts to draw additional blood cultures and order a complete blood count (CBC) to evaluate for potential infection. The CBC reveals an increased white blood cell count of 14,500/mm³, with a left shift indicating neutrophilia, which supports the suspicion of an infectious etiology. Concurrently, the team revisits the patient's recent travel history and dietary intake to identify potential sources of infection. They also review her antibiotic history, given her penicillin allergy, to ensure that any necessary antimicrobial therapy is both effective and safe.

As they await culture results, the team decides to initiate empirical antibiotic therapy using a broad-spectrum agent that is considered safe for patients with penicillin allergies, such as a macrolide or fluoroquinolone. The team continues to monitor the patient’s electrolytes closely, with plans to adjust her potassium supplementation as needed. With her sodium levels slowly improving, they remain hopeful that with the combination of gastrointestinal decompression, targeted hydration, and appropriate antimicrobial therapy, her condition will stabilize further. Through careful monitoring and timely intervention, the team aims to prevent additional complications and guide her toward recovery.

Section 4

As the patient continues under the healthcare team's vigilant care, a new complication emerges. Despite the initial improvement in abdominal distension and partial relief from the nasogastric decompression, the patient begins to exhibit signs of worsening gastrointestinal dysfunction. Over the next 24 hours, her abdominal pain intensifies, and she describes it as more localized to the right lower quadrant. On physical examination, there is increased tenderness upon palpation, and guarding is noted. Bowel sounds remain hypoactive, and the patient's discomfort increases with movement. These new findings raise concerns about the development of a secondary complication, such as an appendiceal or diverticular process.

In light of these changes, the healthcare team promptly orders an abdominal CT scan to elucidate the cause of the localized pain and assess for any structural abnormalities or complications such as abscess formation or perforation. The imaging reveals wall thickening and edema in the terminal ileum, suggestive of an evolving infectious or inflammatory process, potentially indicating ileitis or a localized abscess. The team recognizes the need for further refinement of her antibiotic regimen to specifically address these findings and prevent further progression of her condition.

Concurrently, the patient's laboratory results show a further elevation in the C-reactive protein (CRP), now at 12 mg/L, supporting the presence of an ongoing inflammatory process. Her electrolyte panel indicates a mild hypokalemia at 3.3 mmol/L, necessitating careful potassium supplementation to prevent cardiac complications. With the imaging and lab results guiding their decisions, the team discusses escalating her antibiotic therapy to include coverage for potential anaerobic bacteria, while also consulting with a gastroenterologist to explore additional interventions, such as potential drainage of any abscess, should her condition not stabilize promptly. The team remains vigilant, balancing aggressive treatment with attentive monitoring to support the patient's recovery.

Section 5

As the healthcare team continues to monitor the patient, they notice a change in her overall status. Despite the adjustments in her antibiotic regimen and careful management of her electrolyte imbalance, the patient's condition deteriorates further. Her vital signs show an increasing trend in heart rate, now at 110 beats per minute, and a slight drop in blood pressure to 100/60 mmHg, raising concerns about her hemodynamic stability. The patient reports feeling increasingly weak and nauseated, with a noticeable decrease in her urine output over the past few hours, suggesting potential volume depletion or ongoing systemic inflammation.

A repeat laboratory evaluation reveals a rising white blood cell count, now at 15,000/mm³, indicative of a possible infectious process that is not yet adequately controlled. Additionally, her serum lactate level is mildly elevated at 2.5 mmol/L, which may point towards early tissue hypoperfusion or ongoing gastrointestinal compromise. These findings prompt the healthcare team to reassess the current management plan. They initiate intravenous fluid resuscitation to address the suspected hypovolemia and consider the need for more broad-spectrum antibiotic coverage or potential antifungal therapy, given the risk of a complex infectious etiology.

The team also consults with the gastroenterologist and a surgical team to discuss the potential need for an exploratory laparotomy or percutaneous drainage if an abscess is confirmed as the source of infection. Meanwhile, they implement more frequent monitoring of the patient's vital signs and urine output to quickly detect any further deterioration. Through this comprehensive approach, the team aims to stabilize the patient and address the underlying causes of her worsening condition, all while preparing for potential surgical intervention should her symptoms persist.