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Adult Health 1 case study presentation

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Health History

A 68-year-old Caucasian female presents with a 3-day history of nausea, vomiting, and

generalized weakness. Past medical history is significant for type 2 diabetes mellitus and

hypertension. Current medications include metformin, lisinopril, and hydrochlorothiazide. She

reports poor oral intake over the past few days due to nausea. Upon admission, vitals are stable

except for a slightly elevated blood pressure of 145/92 mmHg. Physical exam is unremarkable

except for dry mucous membranes. Initial labs reveal a serum sodium of 125 mEq/L.

Laboratory/Diagnostic Testing

The diagnostic tests ordered included a basic metabolic panel, complete blood count, and

urinalysis. The basic metabolic panel revealed hyponatremia (serum sodium 125 mEq/L, normal

range 135-145 mEq/L), hyperglycemia (blood glucose 210 mg/dL, normal range 70-99 mg/dL),

and elevated blood urea nitrogen (BUN) and creatinine levels, indicating dehydration and

possibly acute kidney injury (Liang et al., 2020). The complete blood count was within normal

limits, and the urinalysis showed no signs of infection or glucosuria. These tests were ordered to

evaluate electrolyte imbalances, hydration status, and potential underlying causes of

hyponatremia, such as diabetes insipidus, syndrome of inappropriate antidiuretic hormone

secretion (SIADH), or kidney dysfunction.

Collaborative Management

The initial management plan for this patient with hyponatremia includes fluid

resuscitation with normal saline, along with cautious correction of serum sodium levels to avoid

complications such as osmotic demyelination syndrome (Tandukar et al., 2021). Medications

ordered include intravenous normal saline at a rate of 100 mL/hour, and her previous

medications (metformin, lisinopril, and hydrochlorothiazide) have been held temporarily. A strict
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intake and output monitoring protocol has been implemented, and the patient has been advised to

follow a sodium-restricted diet upon improvement of her condition.

The healthcare team involved in managing this patient's care comprises a

multidisciplinary approach. The team includes a physician, a nurse practitioner, a registered

nurse, a dietitian, and a case manager. The physician and nurse practitioner are responsible for

assessing the patient's condition, ordering necessary tests and treatments, and monitoring the

patient's response to therapy (Taberna, 2020). Registered nurses play a crucial role in

administering medications, monitoring vital signs, and providing ongoing assessment and care

coordination. The dietitian has been consulted to develop an appropriate dietary plan that

addresses the patient's hyponatremia and diabetes mellitus. The case manager will facilitate the

patient's transition to the next level of care, ensuring proper discharge planning and coordination

of follow-up appointments and services.

The interdisciplinary goals for this patient include correcting the electrolyte imbalance,

managing her comorbidities (diabetes and hypertension), optimizing hydration status, and

providing education on lifestyle modifications to prevent future episodes of hyponatremia. The

nurse collaborates closely with the healthcare team by accurately documenting the patient's

condition, administering prescribed medications and treatments, monitoring for adverse effects,

and providing ongoing communication and coordination among team members. Additionally, the

nurse plays a vital role in educating the patient and family about the condition, treatment plan,

and self-management strategies.

Plan of Care 1: Priority Physiological Nursing Diagnosis

Nursing Fluid Volume Deficit related to excessive vomiting and poor oral intake as evidenced by hyponatremia,
Diagnosis dry mucous membranes, and elevated BUN and creatinine levels.
Short-term Within 24 hours, the patient will exhibit improved hydration status as evidenced by a serum sodium level of
Goal 130 mEq/L and decreased BUN and creatinine levels.
Long-term Within 72 hours, the patient will achieve adequate hydration as evidenced by a serum sodium level within the
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Goal normal range (135-145 mEq/L), well-hydrated mucous membranes, and normal BUN and creatinine levels.
Nursing Interventions Rationales
1. Administer intravenous normal saline as prescribed, monitoring for Fluid resuscitation is necessary to correct
signs of fluid overload. hyponatremia and dehydration.
2. Strictly monitor intake and output, including daily weights. Accurate fluid balance assessment is crucial for
managing fluid volume status.
3. Encourage oral fluid intake as tolerated, offering small, frequent Promoting adequate oral hydration can help restore
sips of water or electrolyte-rich fluids. fluid balance.
4. Assess for signs and symptoms of overcorrection of hyponatremia, Rapid correction of hyponatremia can lead to
such as headache, nausea, vomiting, and neurological changes. complications like osmotic demyelination syndrome.
5. Collaborate with the dietitian to develop an appropriate sodium- Dietary modifications may be necessary to prevent
restricted diet plan upon improvement of hydration status. future episodes of hyponatremia.
Evaluative Statements
1. The patient's serum sodium level increased to 130 mEq/L within 24 hours.
2. The patient's BUN and creatinine levels showed a decreasing trend, indicating improved hydration status.
3. Patient tolerated oral fluids well and reported decreased thirst and dry mouth.
4. No signs of fluid overload or overcorrection of hyponatremia were observed.
5. The patient expressed an understanding of the importance of following a sodium-restricted diet plan upon discharge.

Potential Patient Education Needs

1. Explanation of hyponatremia and its potential causes.
2. Importance of maintaining adequate hydration and monitoring fluid intake.
3. Dietary modifications to manage hyponatremia and comorbidities (e.g., diabetes mellitus).

Plan of Care 2: Priority Psychosocial Nursing Diagnosis

Nursing Deficient Knowledge related to hyponatremia management and self-care strategies as evidenced
Diagnosis by the patient's lack of understanding of the condition and treatment plan.
Short-term Within 24 hours, the patient will verbalize an understanding of hyponatremia and the importance of
Goal adhering to the treatment plan.
Long-term Before discharge, the patient will demonstrate knowledge of self-management strategies for
Goal hyponatremia and comorbidities, including dietary modifications and monitoring fluid intake.
Nursing Interventions Rationales
1. Assess the patient's current level of understanding about Identifying knowledge gaps is essential for
hyponatremia, its causes, and potential complications. tailoring education efforts.
2. Provide simple, clear explanations about hyponatremia, its Patient education facilitates self-management
treatment, and the importance of adhering to the prescribed regimen. and adherence to the treatment plan.
3. Involve family members or caregivers in the education process, if Family involvement can reinforce learning and
appropriate, to ensure a supportive environment for self-care. promote adherence.
4. Provide written educational materials or refer to reliable online Supplementary materials can reinforce verbal
resources for further understanding. instructions and serve as a reference.
5. Encourage the patient to ask questions and clarify any Open communication and addressing concerns
misunderstandings or concerns. can improve understanding and adherence.
Evaluative Statements
1. Patient verbalized understanding of hyponatremia and its potential consequences if left untreated.
2. Patient demonstrated comprehension of the importance of fluid resuscitation and monitoring fluid intake.
3. The patient acknowledged the need for dietary modifications and expressed willingness to follow a sodium-restricted
diet plan.
4. Family members participated in the education process and expressed commitment to supporting the patient's self-care
efforts.
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5. The patient asked relevant questions and sought clarification on aspects of hyponatremia management.
Potential Patient Education Needs
1. Explanation of hyponatremia, its causes, and potential complications.
2. The importance of adhering to the prescribed treatment plan, including fluid resuscitation and medication
management.
3. Dietary modifications for hyponatremia and comorbidities (e.g., diabetes mellitus, hypertension).

References
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Liang, W., He, X., Xue, R., Wei, F., Dong, B., Wu, Z., Owusu‐Agyeman, M., Wu, Y., Zhou, Y.,

Dong, Y., & Liu, C. (2020). Association of hyponatremia and renal function in type 1

cardiorenal syndrome. European Journal of Clinical Investigation, 50(9).

https://doi.org/10.1111/eci.13269

Taberna, M. (2020). The multidisciplinary team (MDT) approach and quality of care. Frontiers

in Oncology, 10(85). https://doi.org/10.3389/fonc.2020.00085

Tandukar, S., Sterns, R. H., & Rondon-Berrios, H. (2021). Osmotic demyelination syndrome

following correction of hyponatremia by ≤10 mEq/L per day. Kidney360, 2(9), 1415–

1423. https://doi.org/10.34067/kid.0004402021