Case Study: Dehydrated Client Collapsing at Work (Nursing)

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.