Caring for Clients to Maintain Homeostasis and to promote Fluid-electrolyte and Acid-base Balance. >Caring for Clients with Vascular Access Devices.
on line discussion with two questions and self reflection
1.Online Learning Activity- Match the Answer Game:
Analyze the following client ABG results and share your rationale in the discussion forum:
pH- 7.5 PaCO2 (mm Hg)- 30 HCO3 (mEq/L)- 23 PaO2 (mm Hg)- 98
pH- 7.3 PaCO2 (mm Hg)- 50 HCO3 (mEq/L)- 25 PaO2 (mm Hg)- 68
pH- 7.36 PaCO2 (mm Hg)- 64 HCO3 (mEq/L)- 35 PaO2 (mm Hg)- 72
pH- 7.05 PaCO2 (mm Hg)- 77 HCO3 (mEq/L)- 17 PaO2 (mm Hg)- 56
Uncompensated respiratory alkalosis with normal oxygenation _____
Compensated respiratory acidosis with mild hypoxemia (an example of a patient with stable COPD) _____
Uncompensated respiratory acidosis with mild hypoxemia _____
Combined respiratory and metabolic acidosis with mod. hypoxemia _____
Reference: Pruitt B. (2010). Interpreting ABGs: An inside look at your patients status. Nursing 2010 40(7) 31-35.
2.Online Learning Activity- Case Study:
Select any two (2) questions from i) to xi) related to the case study and post/ respond in the online learning activities- discussions area. Incorporate and cite information from the course readings to support your discussion
Case study: Ms. M is 24 years of age and is admitted after experiencing severe nausea vomiting diarrhea and sweating for 4 days. While taking the initial history Mrs. M states I am very anxious right now as you can tell by me breathing fast. I havent been able to keep any food down for a few days. Some of the physicians orders included blood work arterial blood gases urine and stool sampling as well as initiating an IV of 0.9% sodium chloride.
What are the common physiological (sympathetic nervous system) responses to stress and what is the purpose of these effects?
What clinical manifestations would the nurse anticipate Ms. M. may demonstrate in this situation? Explain why.
What priority nursing assessments should be initiated with Ms. M? Explain why.
Why is stool sampling ordered and what actions should the nurse initiate upon Mrs. Ms admission to the unit?
What specific lab values may be elevated or reduced in this situation? Explain why.
What information does a blood gas analysis provide and what results would the nurse anticipate in relation to this case study?
What acid-base disturbance can result from hyperventilation and what are the resulting nursing measures?
What are some applicable stress reduction strategies the nurse can discuss with Ms. M at this time?
What vascular access device (IV) is the most appropriate in this situation? Explain why?
What are the nursing measures to prevent septicemia and other infections related to IV therapy?
What are some potential local complications associated with IV therapy and what nursing measures would be required?
Reflect on your current clinical knowledge and nursing skill competence level by reviewing the following questions.
What is my knowledge in relation to the role of the registered nurse when caring for and with clients experiencing alterations in homeostasis as well as fluid-electrolyte and acid-base imbalances?
What is my knowledge in relation to why various Intravenous (IV) solutions are ordered?
What is my knowledge comfort and skill competency level when caring for clients with different vascular access devices?
Appel S. & Downs C. (2008). Understanding acid-base balance. Nursing 2008 38 9-11. doi: 10.1097/01.NURSE.0000336658.39936.0c
Crawford A. & Harris H. (2011). IV fluids: What nurses need to know. Nursing 2011 45(5) 30-38. doi: 10.1097/01.NURSE.0000396282.43928.40
Guthrie D. Dreher D. & Munson M. (2007a). What you need to know about PICCS part 1. Nursing 2007 37(8) 18. doi: 10.1097.01.NURSE.0000282690.82489.39
Guthrie D. Dreher D. & Munson M. (2007b). What you need to know about PICCs part 2. Nursing 2007 37(9) 14-15. doi: 10.1097/01.NURSE.0000287700.18137.f2
Pruitt B. (2010). Interpreting ABGs: An inside look at your patients status. Nursing 2010 40(7) 31-35. doi: 10.1097.01.NURSE.0000383447.25412.d6
Registered Nurses Association of Ontario. (2008a). Nursing best practice guideline: Assessment and device selection for vascular access. Retrieved from http://rnao.ca/sites/rnao-ca/files/Assessment_and_Device_Selection_for_Vascular_Access.pdf
Registered Nurses Association of Ontario. (2008b). Nursing best practice guideline: Care and maintenance to reduce vascular access complications. Retrieved from http://rnao.ca/sites/rnao-ca/files/Care_and_Maintenance_to_Reduce_Vascular_Access_Complications.pdf
Rosenthal K. (2007). What you need to know about ports. Nursing 2007 37(9) 10-11. doi: 10.1097/01.NURSE.0000298013.81214.16
(*The Nursing journal has an app that can be downloaded to smart phones or iPads).
In addition to the citations above the following resources are referenced in this module:
Day R. A. Paul P. Williams B. Smeltzer S. C. & Bare B. G. (2010). Brunner and Suddarths textbook of Canadian medical surgical nursing (2nd ed.). Philadelphia PA: Lippincott Williams & Wilkins.