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.
00:13
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.
00:22
"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
Next number, blood pressure, 82/48.
00:40
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.
00:51
Heart rate, 121.
00:53
Okay, that's high.
00:56
Is that what we expect with dehydration?
Yes, because he has less
intravascular volume.
01:02
We know that his blood pressure will
be low, his heart rate will be high.
01:06
Respiratory rate, 21. Meh,
we're not that impressed with that, right?
That's right along the lines with normal.
01:13
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.
01:22
So we're already thinking about hypovolemia.
01:26
Now, his initial lab work
showed the following:
white cell count of 5.9.
01:31
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.
01:40
See if you can answer high, low, or normal
for each one of those values.
01:50
Okay, do you have yours lined up?
Now let's take a look at the final question.
01:56
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.
02:03
"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.
02:16
I've looked at a CBC:
his white cells, his red cells, his hemoglobin,
his hematocrit, and his platelets.
02:22
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.
02:31
Now, a white blood cell count of 11.2,
Well, what was it before?
It was 5.9.
02:39
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.
02:50
Now let's look at the red cell count.
02:53
Well, before, it was 5.9 and now it's 6.9.
02:57
Okay, would I expect a red
cell count to go up
after I give a dehydrated
patient 4 liters of fluid?
Yeah, no.
03:07
Okay, hematocrit of 46%.
Go back up to the stem.
03:11
The hematocrit was -- let me find it in there.
03:15
The hematocrit was 52%.
03:19
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.
03:29
It's comparing it to the total volume.
03:32
So when they're dehydrated,
and then we rehydrate them,
I know that percentage is going to go down.
03:38
So I'm going to leave that one in.
03:40
Let me look at the platelets.
03:42
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.
03:51
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.
03:59
I know the patient was dehydrated.
04:01
Hematocrit is a percentage
of the total volume.
04:04
We've added more volume
to his intravascular space
because we added 4 liters of IV fluid.
04:11
That's correct. Mr. Bean is not bleeding
out. It's just his percentage.
04:15
The hematocrit will change because we
rehydrated him with a fair amount of IV fluid.
04:22
Okay, so, see what we did there.
04:23
First of all, we took a very long question,
broke it down piece by piece.
04:28
We looked at his diagnosis, which
was extreme dehydration.
04:31
We looked at all his assessment information,
asked if it was normal or abnormal,
or high or low.
04:37
And then we started looking
at the answer choices,
forced ourselves to eliminate each answer
choice to come up with the correct answer.
04:44
Last tip, remember the very last sentence.
04:49
"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.
The lecture Case Study: Dehydrated Client Collapsing at Work (Nursing) by Rhonda Lawes, PhD, RN is from the course Complete Blood Count (CBC) (Nursing).
A client is admitted after working in the garden on a hot summer day. The client's vital signs include a heart rate of 134 bpm, a respiratory rate of 24 bpm, and blood pressure of 90/50. Which lab results support the given data?
What does the hematocrit measure?
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