K.W. has experienced gastroenteritis, which is an infection of the stomach and intestines. The symptoms of gastroenteritis include nausea, vomiting, and diarrhea. These symptoms are caused by an increase in fluid volume from the intestines flooding out into the rest of the body through the digestive tract (Verma & Kuragayala, 2022). The increased volume causes an increase in blood volume to compensate for it, which results in hypovolemia.
Medications and treatments ordered for patient
For K.W.s medication, the nurse ordered 1000 ml of 0.9% NS for her IV line when she was in one of her shifts. The patient was also given another 1000 ml of 0.9 % NS in the course of her shifts and that caused her to infuse 100 ml/hr into the patient’s right hand where at the end, she received 800 ml of IV fluids for the whole of the night shift (assuming that she did not diarrhea or vomit).
Analysis: Relevance of labs and diagnostic test results
The eGFR is 20 mL/min/1.73 m2, which is high although not abnormal because the patient has not been able to maintain her fluid intake. The patient’s sodium and potassium levels are notably low, which could be a sign of dehydration; however, they are also low in healthy patients who have been fasting for 12 hours and above even though more tests will be needed to determine if dehydration is present.
The BUN indicates that she once had some kidney injury; although, it was not sufficient to cause AKI as evidenced by a Hct of 49%. This however, does not rule out AKI because other factors may have contributed to her dehydration such as vomiting and diarrhoea. A CBC will be done the following day to look for anaemia, leucocytosis or thrombocytopenia; these findings would suggest infection or bleeding somewhere in the patient’s body.
Day-of-care assessment data
This patient’s initial assessment was normal for a person in her stage of illness. Pressure from her perfusion and cardiac outputs were both high, indicating that she had no trace of organ dysfunction at that stage. Her pulmonary artery wedge pressure was also normal, so there were no signs of pulmonary edema. Her serum electrolyte levels were also normal, so she did not have any signs of hypoperfusion or dehydration. Her physical examination was also normal, including her blood pressure, pulse rate and rhythm, BS, pedal pulses, and respiratory rate. Her temperature was 37.2*C (99.0*F), which is above normal but within the usual range considering the season.
Delegation and Collaboration
K. W.’s condition is stable and improving. She has had no vomiting or diarrhea, which is a good sign for her recovery from gastroenteritis. Her Braden score indicates that she is still confused but alert and oriented to person, place, and situation. Her lungs are clear and she has a regular apical pulse rate, although it is slightly elevated in all quadrants. Her BS is still hyperactive in all quadrants, indicating she may be experiencing some dysautonomia related to her gastroenteritis.
Principles of delegation
As a provider, you are responsible for the care of your patients. You must make sure that your patients receive the highest quality of care possible. One way to do this is by delegating some of your responsibilities to other providers who have been trained and certified in specific areas.
There are 5 types of rights of delegation for RNs. They include:
- Right Task
- Right Circumstances
- Right
- Right Direction/ Communication
- Right Supervision/ Evaluation
The ethical dilemma presented to the nurse is whether to inform K. W.’s husband of his wife’s admission, even though it is against the patient’s wishes. The nurse must consider the patient’s autonomy and confidentiality in deciding whether or not to inform him, because informing him could potentially compromise the patient’s privacy and security. The nurse has a responsibility to uphold both ethical principles when making decisions about disclosing information about patients’ conditions or treatments.
Reference
Verma, M. K., & Kuragayala, S. D. (2022). Mastery of Acute Kidney Infection (aki),(complex syndrome) mystery.