Bob Jones, age 35, finishes running his first marathon in 88F heat with a time of 4 hours and 22 minutes. Shortly after crossing the finish line he collapses but does not lose consciousness. In the medical tent he c/o lightheadedness, nausea, a dry mouth and muscle cramps in his lower extremities. VS are BP 88/52, P 138, R 28 and T 99F.

Do you think Bob has a fluid imbalance? If yes, what kind?

What lead you to this conclusion?

If a BUN and creatinine were drawn, what would you expect to see?

An IV is started at 300 ml/hr. What type of IV fluids?

After 45 minutes, Bob reports his lightheadedness is gone. He is still experiencing some cramping in his legs. What other labs should be checked?

What could be causing the cramping?

Identify possible nursing diagnoses and interventions for Bob



John and Lisa Kent are driving through the Arizona desert when their rental car ran out of gas. It is a sunny 120 degrees, with no shade. Within 10 minutes, Lisa c/o headache and dizziness.

What could be the cause of her symptoms?

What are other s/s of this problem?

Throughout the afternoon, John and Lisa slowly ration the fruit and soft drinks they had with them. By sunset, it has cooled to 100F. John c/o nausea, he is not perspiring. Lisa’s headache remains and she is tachycardic. Both are lethargic. Who is in greater danger of a fluid and electrolyte imbalance?

John begins vomiting during the night. What electrolyte imbalance will result?

What is a good source of this electrolyte?

What fatal complication can occur with this electrolyte imbalance?

Early in the morning, a truck driver finds John and Lisa. They are lethargic, warm. He calls for

help and they are transported to a hospital 80 miles away.

What electrolyte replacements will they need?

What observations would indicate recovery?

Identify possible nursing diagnoses and interventions for the couple.



Mark Black is a 28-year-old snow boarder who is found by the ski patrol several hours after a

fall on the slopes. He is incoherent. His pulse is slow and irregular, respirations are slow, pupils

are dilated and muscles are rigid. He is wrapped in blankets and placed on a sled. Back at the lodge, his body temperature is 90F. His left hand is numb, swollen and painful.

What initial interventions should be employed to prevent cellular damage from frostbite?

During rewarming, fluids shift out of cells and capillaries. This leads to what fluid problems?

What labs would be important to evaluate?

Mark has an elevate K level. Why?

His Hct is also elevated. IV fluids are ordered. What type of IV fluid will be given and why?

Mark is attached to a cardiac monitor because he is in danger of developing cardiac arrhythmias.


Mark requests a cigarette when he is feeling better. Should he be allowed to smoke?

Identify possible nursing diagnoses and interventions for Mark



Lauren Scott is a 20-year-old college student who is brought to the ED by her college roommate.

According to her roommate, she has had the flu with vomiting and diarrhea for two days. Lauren is lethargic; her skin is warm and flushed. Mucous membranes are dry. VS are: BP 86/50, P 120, R 24, and T 99.5F. She does not remember when she last voided.

What fluid imbalance is Lauren experiencing?

What s/s lead to this conclusion?

An IV of D5½NS with 40 mEq KCl is started at 200 ml/hr. The nurse hangs the IV and manually sets the rate because an infusion pump is not available. The nurse becomes busy with other patients for approximately two hours. When she returns to check on Lauren, she finds that the entire 1000 ml of fluid has infused. Lauren is coughing and complaining of dyspnea. Her lungs have crackles.

What fluid imbalance is Lauren now experiencing?

What are other s/s of this problem?

What can be done to correct this problem?

Electrolyte levels are drawn. Lauren’s K is 5.8.

What are some s/s of Hyperkalemia?

What could be given to lower K?

Identify possible nursing diagnoses and interventions for Lauren