Assignment Task: The following information will be used for the next three questions.
M.S., an 85-year-old retired engineer, seems somewhat confused when his daughter comes home from work. She takes him to the emergency department, where his blood pressure is 90/62, his heart rate is 114 and his skin is dry but cool. His daughter says that he seems "much weaker" than usual, and he is unable to answer questions clearly. His daughter reports that he has "lost his appetite" lately and has not taken in much food or drink. The nurse starts an IV infusion of 0.9% sodium chloride (NS) at 100 mL/hr via a gravity drip infusion.
1) What do you think is M.S.'s main medical problem at this time?
2) The emergency department is very busy, and when the nurse returns in 15 minutes, she is shocked to see that almost the entire 500-mL bag of NS has infused within 1 hour.
What went wrong? What will the nurse do first, and what will the nurse watch for at this time?
3) Twenty-four hours after his admission, M.S. is much less confused and is able to move to a chair for lunch without much difficulty. He is receiving D5 ½ NS with 20 mEq of potassium chloride at a rate of 75 mL/hr via an infusion pump. His daughter notices that the area above the intravenous insertion site is red, and M.S. complains that the area is "very sore."
What went wrong? What needs to be done at this time?