Mrs Davis, a fragile 76 year old woman is admitted to the hospital after 5 days of vomiting. She has been unable to eat anything for that time period. Her usual weight is 126 lb. On admission her weight is 118 lb. Assessment reveals dry, cracked lips, poor skin turgor. BP= 88/72mmHg, Pulse=102bpm, Respiratory rate (RR)=20, Temp = 38.6ºC. Urine output over the next 8 hours is 100 ml.
1. What signs and symptoms would suggest Mrs. Davis is hypovolemic?
2. What evidence is there that her body is trying to compensate for the loss of fluid? Explain the mechanisms involved.
3. Mrs. Davis passed 100 ml of urine in 8 hours, if this continued at the same rate how much urine would she pass in 24 hours? Is this normal?
4. Mrs. Davis is in fluid imbalance from her continuous vomiting and lack of intake for 5 days. List some other common causes for fluid imbalance.
5. If Mrs. Davis's hypovolemia were associated with hypernatremia would body cells shrink or swell? Why?
6. What are normal sodium and potassium levels? What are these ions used for? What are the primary compartments in which they are found.
7. Name some common food sources of sodium and potassium. Can you name food sources for phosphorous, calcium and magnesium as well?
8. What mechanisms does the body use to maintain fluid balance. Draw a concept map representing these mechanisms.
9. Is Mrs. Davis's fluid imbalance associated with hyponatremia or hypernatremia? Hypokalemia or hyperkalemia? What kind of risks do these imbalances pose for her?
10. State 3 - 5 reasons why elderly people are more at risk for dehydration than young adults.