Case Study: Dehydrated Client Collapsing at Work (Nursing)

by Rhonda Lawes

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    00:01 "Mr. Bean was admitted after collapsing at his job working on a road construction crew with extreme dehydration." So let's take a look at that.

    00:10 I know he is working at a job construction crew.

    00:14 He has extreme dehydration, so I'm going to be worried about what goes along with dehydration; blood pressure, shock, so we're worried about those things.

    00:23 "His initial vital signs were temperature 39.0°Celsius, or 102.2°Fahrenheit." Is that high, low, or normal? Whoa, that's definitely high.

    00:36 Does that line up with dehydration? Yes.

    00:39 We know that patients that are dehydrated have elevated temperatures.

    00:42 Next number, blood pressure, 82/48.

    00:46 That's very low, right? Does that line up with dehydration? Yes, because he has less intravascular volume, we would expect that his blood pressure would be low.

    00:57 Heart rate, 121.

    01:00 Okay, that's high.

    01:02 Is that what we expect with dehydration? Yes, because he has less intravascular volume.

    01:09 We know that his blood pressure will be low, his heart rate will be high.

    01:13 Respiratory rate, 21. Meh, we're not that impressed with that, right? That's right along the lines with normal.

    01:19 So we know, so far, Mr. Bean is dehydrated, his vital signs are abnormal, his temp is up, his blood pressure is down, his heart rate is up.

    01:29 So we're already thinking about hypovolemia.

    01:32 Now, his initial lab work showed the following: white cell count of 5.9.

    01:38 Okay, pause for just a minute. I want you to work through the white cell count, the red cell count, the hemoglobin, and hematocrit without me.

    01:47 See if you can answer high, low, or normal for each one of those values.

    01:57 Okay, do you have yours lined up? Now let's take a look at the final question.

    02:02 See, the last sentence of the question is really going to give you an idea of what we're looking for. It's the last part to focus your brain.

    02:10 "After receiving 4 liters of IV fluid, which of the following changes would you expect to see in his follow-up CBC?" Okay, so I know he's dehydrated. He's got abnormal vital signs.

    02:23 I've looked at a CBC: his white cells, his red cells, his hemoglobin, his hematocrit, and his platelets.

    02:29 What am I going to expect to see in his follow up? So you've written A, B, C, and D down on your scratch paper.

    02:38 Now, a white blood cell count of 11.2, Well, what was it before? It was 5.9.

    02:46 So would I expect that when I give somebody 4 liters of IV fluid, their white cell count to shoot up above normal? No, so I can eliminate that one.

    02:57 Now let's look at the red cell count.

    02:59 Well, before, it was 5.9 and now it's 6.9.

    03:04 Okay, would I expect a red cell count to go up after I give a dehydrated patient 4 liters of fluid? Yeah, no.

    03:13 Okay, hematocrit of 46%. Go back up to the stem.

    03:17 The hematocrit was -- let me find it in there.

    03:22 The hematocrit was 52%.

    03:25 Would I expect the hematocrit to go down after 4 liters of fluid? Wait a minute. Something in my brain says -- Oh, that's right. Hematocrit is a percentage.

    03:36 It's comparing it to the total volume.

    03:39 So when they're dehydrated, and then we rehydrate them, I know that percentage is going to go down.

    03:45 So I'm going to leave that one in.

    03:47 Let me look at the platelets.

    03:49 Would I expect the platelets to go down after 4 liters of fluid? No. Fluid shouldn't affect that. So, I think it's number C.

    03:58 So let me go back and take a look at that. Does it make sense that the hematocrit would drop? Yeah, absolutely, because I've already thought through that.

    04:05 I know the patient was dehydrated.

    04:08 Hematocrit is a percentage of the total volume.

    04:11 We've added more volume to his intravascular space because we added 4 liters of IV fluid.

    04:17 That's correct. Mr. Bean is not bleeding out. It's just his percentage.

    04:22 The hematocrit will change because we rehydrated him with a fair amount of IV fluid.

    04:28 Okay, so, see what we did there.

    04:30 First of all, we took a very long question, broke it down piece by piece.

    04:34 We looked at his diagnosis, which was extreme dehydration.

    04:38 We looked at all his assessment information, asked if it was normal or abnormal, or high or low.

    04:44 And then we started looking at the answer choices, forced ourselves to eliminate each answer choice to come up with the correct answer.

    04:51 Last tip, remember the very last sentence.

    04:55 "After getting 4 liters of IV fluid, which of the following changes would you expect to see?" That will help you make sure you have the meat of the question.

    About the Lecture

    The lecture Case Study: Dehydrated Client Collapsing at Work (Nursing) by Rhonda Lawes is from the course Complete Blood Count (CBC) (Nursing).

    Author of lecture Case Study: Dehydrated Client Collapsing at Work (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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