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Fluids Case Study Review: Mr. Cooper
Mr. Cooper, age 65, is a widower and lives alone. He is lethargic with hyperreflexic deep tendon reflexes. He
had been in his usual state of good health until this week, and has no significant health history other than mild
hypertension, which is being treated with diet and exercise. He takes no medications, other than a daily
multivitamin. He has been vomiting persistently for 3 days with watery diarrhea, and a relative brought him to
the emergency room. On admission, he weighed 153 pounds. His original weight was 165 pounds (75 kg). The
nurse assessed his fluid state and noted that his mucous membranes and skin were dry. His temperature was
99.4 F (37.5 C), pulse 112, respirations 32, blood pressure 110/88, and urine output in 8 hours 125 mL with a
specific gravity of 1.032. Electrolyte findings were serum K+ 3.5 mEq/L; Na+ 159 mEq/L; and Cl- 120 mEq/ L.
His hematocrit and BUN were elevated. Serum glucose was 72 mg/ dl.
1. The nurse assesses Mr. Cooper's body fluid state. Name four of his symptoms and laboratory findings that are
suggestive of the fluid imbalance (dehydration):
Serum electrolytes: Na+ 159 mEq/L; Cl- 120 mEq/L
Vital signs: tachycardia, tachypnea, low-grade fever
Weight loss (165  153 lbs in 3 days) and low urinary output (125 mL in 8 hours)
Presentation: lethargic, dry mucous membranes and skin
Other laboratory values:  Hct, BUN, urine SG
2. Determine the percentage of Mr. Cooper's body weight loss:
(165  153) = 12 = 7.27%
165
165
3. Mr. Cooper's total fluid loss is:
165  153 lbs = 12 lbs
1 kg 
2.2 lbs
12 lbs
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= 12  2.2 = 5.45 kg = 5.45 liters of fluid loss over 3 days
4. Clinically, Mr. Cooper has which of the following:
a. Mild dehydration
b. Moderate dehydration (< 8%)
c. Severe
d. Fatal
5. Which type of hypernatremia is Mr. Cooper experiencing (water loss or sodium gain)?
Water loss hypernatremia
6. Name the type of Mr. Cooper's dehydration:
Hypertonic dehydration
7. What is the rationale for your selection?
More water loss than sodium; hypernatremia.
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8. State the priority nursing diagnosis for Mr. Cooper:
Deficient Fluid Volume r/t excessive hypotonic fluid loss resulting in more solute, less body water 2 to
intractable nausea and watery diarrhea, AEB: weight loss, decreased skin turgor and dry membranes, lab values,
tachycardia
9. What do you, as the emergency room nurse, anticipate to be the priority nursing and collaborative
interventions for Mr. Cooper?
Assess vital signs (particularly orthostatic blood pressure, pulse) initially, to determine baseline, and then
frequently throughout therapy.
Start and maintain an IV line and administer fluids at prescribed rates.
Rehydration with hypotonic IV fluids (slowly)
Treat underlying cause (medications as prescribed for nausea and diarrhea)
Rule out any infection
Careful monitoring of client response to rehydration therapy:
Blood pressure, pulse, strict I & O, daily weight, skin turgor, level of consciousness, electrolytes
(especially serum sodium), urine SG, Hct, BUN
Make sure all safety precautions are in place (bed in low position, call bell within reach, side rails up X 3).
Monitor postural heart rate and blood pressure closely when getting Mr. Cooper out of bed. Have him take
several minutes to get up, go in slow steps from a lying to a sitting to a standing position. Be sure someone is
present when he gets out of bed.
10. What two laboratory results were indicative of dehydration other than the electrolytes?
 Hct , BUN; SG of 1.032
11. Which intravenous solution(s) would be most appropriate for Mr. Cooper?
D5W, 0.45% NaCl