A post operative patient is receiving dextrose 5% and 0.45 normal saline at 160 ml/hour. The nurse notices puffiness, weight gain of 2 kg and hypotension with complaints of muscle cramps and confusion. The serum sodium level is 126 mEq/L. Which of the following is the most likely cause of these findings?
Fluid overload and hyponatremia
The patient is receiving a hypotonic infusion (5% dextrose with 0.45% saline) at a high rate of 160 ml/hour.
Puffiness and a 2 kg weight gain indicate retention of excess fluid — fluid overload.
Serum sodium of 126 mEq/L (normal 135–145) is hyponatremia; excess free water dilutes sodium. Low sodium causes muscle cramps and confusion (cerebral oedema).
The hypotension reflects the effect of severe hyponatremia, with fluid shifting out of the vessels into the tissues; the weight gain and puffiness still point to fluid overload.
Dehydration is ruled out by the weight gain and oedema, and nothing suggests excess dietary sodium or potassium deficiency.
Hence, Fluid overload and hyponatremia.
Similar Questions
In a patient with a normal temperature and pulse but low blood pressure, which clinical condition should be considered first?
When caring for a patient with hypocalcemia, which symptom should the nurse closely observe?
A patient with a peptic ulcer is prescribed a proton pump inhibitor and advised to avoid NSAIDs. Which rationale best explains this combined approach?
A nurse encounters four patients after a mass casualty event. Who should be given the highest triage priority?
A patient arrives with severe burns. After ensuring a patent airway, what is the next step in the emergency management?
During a morning assessment, a nurse notes that a patient has cool, clammy skin, a weak pulse, and decreased urine output. What is the most appropriate nursing action based on these findings?
A nurse is tasked with teaching newly diagnosed hypertensive patients about medication adherence. What approach reflects effective teaching responsibility?
A nurse is evaluating elimination needs of a patient with a newly established colostomy. Which action demonstrates best practice for promoting self-care?
During a complex surgical procedure, the surgical team realizes a critical piece of equipment is malfunctioning. What is the most appropriate action for the nurse in charge of operation theatre supplies?
During nebulization for a patient with chronic obstructive pulmonary disease (COPD), the nurse notes that the medication is not visibly misting. What is the best nursing action to address this issue?
Important Questions from Medical-Surgical Nursing
In a patient with a normal temperature and pulse but low blood pressure, which clinical condition should be considered first?
When caring for a patient with hypocalcemia, which symptom should the nurse closely observe?
A patient with a peptic ulcer is prescribed a proton pump inhibitor and advised to avoid NSAIDs. Which rationale best explains this combined approach?
A nurse encounters four patients after a mass casualty event. Who should be given the highest triage priority?
A patient arrives with severe burns. After ensuring a patent airway, what is the next step in the emergency management?
