A 28-year-old pregnant patient presents with signs of dehydration, including dry mucous membranes and decreased skin turgor. She has hypoactive bowel sounds, a fetal heart rate of 165 bpm, and reports feeling only one fetal movement in the past two hours. Her laboratory results show hyponatremia and elevated BUN levels. Which nursing intervention should be prioritized to address the patient's condition?

B) Initiate intravenous fluid therapy with isotonic saline to restore fluid balance.

A) Encourage the patient to increase oral fluid intake to improve hydration status.

B) Initiate intravenous fluid therapy with isotonic saline to restore fluid balance.

C) Administer antiemetic medication to reduce nausea and vomiting symptoms.

D) Perform an abdominal ultrasound to assess fetal well-being.

A 28-year-old pregnant patient presents with signs of dehydration, including dry mucous membranes, decreased skin turgor, and hypoactive bowel sounds. She also exhibits fetal tachycardia and reduced fetal movements. Laboratory findings show hyponatremia and elevated BUN. Based on this information, which nursing intervention is the priority to address the patient's condition?

B) Administer isotonic saline intravenously to rapidly correct dehydration.

A) Initiate oral rehydration therapy to gradually improve hydration status.

B) Administer isotonic saline intravenously to rapidly correct dehydration.

C) Encourage the patient to rest and monitor fetal movements every hour.

D) Provide a high-protein diet to address ketonuria and improve energy levels.

A pregnant patient receiving intravenous fluid therapy shows signs of improved nausea and vomiting but presents with increased heart rate and decreased blood pressure. The fetal heart rate remains elevated with sporadic decelerations, and urine output is low. What is the most appropriate nursing intervention at this time?

A) Increase the rate of isotonic saline infusion to address potential hypovolemia.

B) Administer an antiarrhythmic medication to stabilize the patient's heart rate.

C) Decrease the rate of fluid infusion to prevent fluid overload.

D) Prepare the patient for emergency delivery due to fetal distress.

A pregnant patient receiving intravenous fluid therapy for dehydration shows a heart rate of 110 bpm, blood pressure of 90/60 mmHg, and urine output of 20 mL/hour. Fetal monitoring reveals sporadic decelerations with a heart rate of 160 bpm. What is the priority nursing intervention at this time?

C) Position the patient in a left lateral position to improve uteroplacental perfusion.

A) Increase the isotonic saline infusion rate to improve maternal hemodynamics.

B) Administer a diuretic to enhance urine output and prevent fluid overload.

C) Position the patient in a left lateral position to improve uteroplacental perfusion.

D) Discontinue the antiemetic medication to prevent further hypotension.

A pregnant patient in her second trimester is being treated for dehydration and hypokalemia. After administration of isotonic saline and potassium chloride, the nurse notes that the patient's blood pressure has improved, but her heart rate remains elevated. Which of the following actions should the nurse prioritize next?

C) Assess the patient's urine output and monitor for signs of renal function improvement.

A) Administer an antiemetic to control nausea.

B) Increase the rate of isotonic saline infusion.

C) Assess the patient's urine output and monitor for signs of renal function improvement.

D) Encourage the patient to ambulate to improve circulatory status.

A pregnant patient receiving isotonic saline infusion shows improvement in blood pressure but presents with a heart rate of 108 bpm and laboratory findings indicating hypokalemia and prerenal azotemia. Which nursing intervention should be prioritized to address the current electrolyte imbalance and prevent further complications?

C) Initiate potassium chloride intravenously and monitor cardiac function.

A) Discontinue the isotonic saline infusion to prevent fluid overload.

B) Administer oral potassium supplements and encourage oral fluid intake.

C) Initiate potassium chloride intravenously and monitor cardiac function.

D) Increase the isotonic saline infusion rate to enhance renal perfusion.

A patient with concurrent hypokalemia and hypomagnesemia is being treated with potassium chloride and magnesium sulfate infusions. Which nursing intervention is most critical to implement to prevent potential complications?

A) Monitor the patient's deep tendon reflexes regularly.

B) Increase the frequency of blood pressure monitoring to every 30 minutes.

C) Ensure the patient maintains a low-sodium diet to prevent fluid retention.

D) Encourage the patient to ambulate frequently to prevent muscle weakness.

A patient receiving potassium chloride supplementation begins to exhibit muscle weakness and mild cramping. Her potassium level is 3.6 mEq/L, and her magnesium level is 1.5 mg/dL. Which of the following actions should the nurse prioritize to address the electrolyte imbalance?

C) Administer magnesium sulfate infusion as ordered.

A) Increase the rate of potassium chloride infusion.

B) Initiate oral calcium supplementation.

C) Administer magnesium sulfate infusion as ordered.

D) Restrict the patient's fluid intake to prevent dilutional hyponatremia.

A patient with gestational hypertension and acute kidney stress is receiving magnesium sulfate and a low-dose antihypertensive regimen. The nurse observes a urine output of less than 30 mL/hour over the past three hours. What is the primary nursing intervention to address this clinical finding?

B) Notify the healthcare provider about the decreased urine output.

A) Increase oral fluid intake to enhance hydration.

B) Notify the healthcare provider about the decreased urine output.

C) Discontinue magnesium sulfate infusion immediately.

D) Increase the rate of potassium chloride infusion to address electrolyte imbalance.

A patient receiving magnesium sulfate for muscle weakness and cramping is now showing signs of worsening renal function, elevated blood pressure, and decreased urine output. What is the priority nursing intervention to address these findings?

C) Notify the healthcare provider and prepare for potential transfer to a higher-level facility.

A) Increase the infusion rate of potassium chloride to correct electrolyte imbalance.

B) Administer a diuretic to increase urine output and reduce blood pressure.

C) Notify the healthcare provider and prepare for potential transfer to a higher-level facility.

D) Encourage oral fluid intake to improve hydration and kidney function.

pregnancy and dehydration - Nursing Case Study

Pathophysiology

• Primary mechanism: During pregnancy, increased blood volume and demand for nutrients elevate fluid requirements. If fluid intake doesn't match the higher needs, dehydration can occur, compromising both maternal and fetal circulation.

• Secondary mechanism: Hormonal changes, particularly elevated progesterone, slow gastrointestinal motility and increase renal water loss, further exacerbating dehydration risk by reducing fluid absorption and increasing urinary output.

• Key complication: Dehydration may lead to reduced amniotic fluid levels, impairing fetal development and potentially triggering preterm labor due to uterine irritability.

Patient Profile

Demographics:

28-year-old female, school teacher

History:

• Key past medical history: Gestational diabetes in previous pregnancy, mild hypertension

• Current medications: Prenatal vitamins, labetalol for hypertension

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe nausea and dizziness

• Key symptoms: Persistent vomiting, dry mouth, fatigue, decreased fetal movement

• Vital signs: Blood pressure 145/95 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 99.1°F, oxygen saturation 97% on room air

Section 1

As the clinical team proceeds with the initial assessment of the 28-year-old pregnant patient, they note several concerning findings that warrant immediate attention. The patient's mucous membranes appear dry, and her skin turgor is decreased, indicative of significant dehydration. Auscultation of the abdomen reveals hypoactive bowel sounds, suggesting slowed gastrointestinal activity. The fetal heart rate is monitored and found to be 165 bpm, slightly tachycardic, which could be a response to maternal dehydration stress. Additionally, the patient reports only feeling one fetal movement in the past two hours, which is less than the expected norm for her gestational stage.

Laboratory results return, providing further insight into the patient's condition. Her serum electrolytes show hyponatremia with a sodium level of 130 mmol/L, and her blood urea nitrogen (BUN) is elevated at 28 mg/dL, both consistent with dehydration. Ketones are present in her urine, indicating that her body is breaking down fat for energy due to insufficient carbohydrate intake, a result of her persistent vomiting. These findings suggest a worsening state of dehydration and potential development of hyperemesis gravidarum, a condition that could further complicate her pregnancy if not addressed promptly.

The clinical team decides to initiate intravenous fluid therapy with isotonic saline to combat the dehydration and address electrolyte imbalances. They also consider administering antiemetic medication to control the patient's nausea and vomiting. Continuous fetal monitoring is implemented to assess the response to rehydration therapy. The team remains vigilant for signs of improvement or deterioration, recognizing that prompt intervention is crucial to prevent further complications such as preterm labor or fetal distress. As the patient's care progresses, the team will need to reassess her fluid status and fetal well-being regularly, adjusting their management plan as necessary to ensure a positive outcome for both mother and child.

Section 2

As the clinical team continues to monitor the patient, they observe a change in her status approximately 6 hours after the initiation of intravenous fluid therapy. The patient reports a slight decrease in nausea, and her vomiting episodes have lessened, suggesting a positive initial response to the antiemetic medication. However, her vital signs reveal new areas of concern: her heart rate has increased to 110 bpm, and her blood pressure has dropped to 90/60 mmHg, indicating possible ongoing fluid deficit or a potential vasodilatory effect from rehydration.

The fetal heart rate, while still elevated, has decreased slightly to 160 bpm, showing potential improvement but still requiring close observation. The continuous fetal monitoring reveals sporadic decelerations, which could signify intermittent fetal stress, necessitating further evaluation. The patient's urine output remains low at 20 mL/hour, despite the fluid therapy, indicating that her kidneys may not be responding adequately to the treatment, potentially due to prerenal azotemia from prolonged dehydration.

In light of these developments, the clinical team decides to adjust the treatment plan. They increase the rate of isotonic saline infusion and order a repeat set of laboratory tests, including a complete blood count and comprehensive metabolic panel, to assess the effectiveness of the current intervention and identify any new electrolyte imbalances or organ dysfunction. The team also consults with an obstetric specialist to evaluate the need for additional interventions to support fetal well-being and prevent complications such as preterm labor. As the patient's journey continues, careful reassessment and timely adjustments to the management plan will be crucial to ensure the health and safety of both the mother and her unborn child.

Section 3

As the clinical team awaits the results of the repeat laboratory tests, they continue to monitor the patient's status closely. Approximately two hours after increasing the isotonic saline infusion, the team observes a slight improvement in the patient's blood pressure, which has risen to 100/65 mmHg. However, her heart rate remains elevated at 108 bpm. The patient reports feeling slightly more energetic, though she still experiences intermittent bouts of nausea. The fetal heart rate has stabilized at 155 bpm, but intermittent decelerations persist, prompting further evaluation of fetal well-being.

The laboratory results arrive, revealing a hemoglobin level of 13.5 g/dL and a hematocrit of 40%, indicating some hemoconcentration despite the fluid therapy, suggesting ongoing dehydration. Electrolyte levels show a mild hypokalemia with a potassium level of 3.2 mEq/L, likely due to persistent vomiting and potential renal adaptations. The blood urea nitrogen (BUN) and creatinine levels are elevated, at 25 mg/dL and 1.5 mg/dL respectively, supporting the suspicion of prerenal azotemia. These findings suggest that despite some clinical improvements, the patient remains at risk for renal and electrolyte complications.

In response to these diagnostic findings, the clinical team decides to further refine the treatment plan. They introduce a potassium chloride supplement to address the hypokalemia and continue to closely monitor electrolyte levels. The obstetric specialist recommends an ultrasound to further evaluate fetal status and rule out structural causes of decelerations. Meanwhile, the focus remains on optimizing maternal hydration and renal perfusion to prevent further complications. The team remains vigilant, knowing that swift and appropriate adjustments are critical in managing both maternal and fetal health effectively.

Section 4

As the clinical team continues to monitor the patient, a new development arises. Approximately three hours after the initiation of potassium chloride supplementation, the patient begins to exhibit signs of electrolyte imbalance correction, with her heart rate decreasing slightly to 102 bpm. However, she starts to experience muscle weakness and mild cramping, prompting the team to reassess her electrolyte status. A repeat blood test reveals that her potassium level has risen to 3.6 mEq/L, indicating an initial positive response to supplementation, but her magnesium level is now noted to be 1.5 mg/dL, suggesting potential concurrent hypomagnesemia.

Recognizing the critical interplay between magnesium and potassium in cellular functions, the clinical team decides to introduce a magnesium sulfate infusion to prevent further complications and support the stabilization of electrolyte imbalances. They carefully titrate the magnesium dose, considering both maternal and fetal safety. In parallel, the obstetrician reviews the results of the fetal ultrasound, which fortunately shows no structural abnormalities but confirms the need for ongoing monitoring due to persistent intermittent decelerations in fetal heart rate.

The patient's clinical status remains a focus of concern as the team anticipates potential new complications, particularly regarding her renal function. Given the elevated BUN and creatinine levels, along with signs of hemoconcentration, the team decides to increase the frequency of renal function monitoring and continue aggressive hydration therapy. They also emphasize the importance of addressing the patient's nausea to improve oral intake and reduce further electrolyte losses. The patient is closely observed for any changes in her clinical status, ready to adjust the treatment plan as necessary to ensure both maternal and fetal well-being.

Section 5

As the clinical team continues to implement the treatment plan, they remain vigilant for any changes in the patient's status. Over the next several hours, the patient's muscle weakness and cramping begin to improve, indicating a positive response to the magnesium sulfate infusion. However, during routine monitoring, the patient's blood pressure begins to trend upwards, measuring at 145/92 mmHg, suggesting the onset of gestational hypertension. The team recognizes the importance of closely managing her blood pressure to prevent complications such as preeclampsia, particularly given her current state of dehydration and electrolyte imbalance.

A new set of diagnostic results comes back, highlighting a concerning trend: the patient's urine output has decreased significantly, with less than 30 mL/hour over the past three hours. Coupled with her rising blood pressure and persistent nausea, these findings suggest worsening renal function, potentially exacerbated by ongoing dehydration and hemoconcentration. Her labs reveal a further rise in BUN and creatinine levels, indicating acute kidney stress. In light of these developments, the clinical team decides to adjust her fluid management strategy, reducing the rate of potassium chloride infusion while maintaining magnesium supplementation to balance electrolyte needs and prevent fluid overload.

The team also initiates a low-dose antihypertensive regimen to manage her blood pressure, carefully considering the impact on both maternal and fetal health. The obstetrician continues to monitor the fetal heart rate closely, which shows periods of stability but intermittent decelerations. As the patient remains under close observation, the clinical team prepares for potential escalation of care, including possible transfer to a higher-level facility if her condition does not improve. They emphasize the importance of ongoing collaborative care, involving nephrology and obstetrics specialists, to navigate the complexities of her condition and ensure the best possible outcomes for both mother and baby.