Question

Your 60 y/o patient with pyelonephritis and possible septicemia has had five UTIs over the past 2 years. She is fatigued from lack of sleep, has lost weight, and urinates frequently even in the night. Her labs show: Sodium 154 mEq/L, osmolarity 340 most/L, glucose 127 mg/dl, and potassium 3.9 mEq/L. Which nursing diagnosis is priority?

A. Fluid volume deficit r/t osmotic diuresis induced by hyponatremia
B. Fluid volume deficit r/t inability to conserve water
C. Altered nutrition: Less than body requirements r/t hyper metabolic state
D. Altered nutrition: Less than body requirements r/t catabolic effects of insulin deficiency

Answer 1

The patient's lab results and symptoms indicate a priority nursing diagnosis of Fluid volume deficit related to the inability to conserve water, due to the presence of hypernatremia and a high serum osmolarity.

Step-by-step explanation:

The priority nursing diagnosis for a 60-year-old patient with pyelonephritis, possible septicemia, frequent urination (including nocturia), fatigue, weight loss, and lab results indicating hypernatremia (Sodium 154 mEq/L), high serum osmolarity (340 most/L), is Fluid volume deficit related to inability to conserve water (B). This diagnosis is supported by lab values showing hypernatremia and high osmolarity, which can contribute to an osmotic diuresis that impairs the kidneys' ability to conserve water.

Osmotic diuresis can occur in conditions such as diabetes mellitus, where glucose in the urine attracts water, leading to polyuria and dehydration. The dehydration may contribute to the patient's fatigue and weight loss. Management would focus on addressing the underlying causes, such as infection (pyelonephritis), and providing appropriate fluid replacement.

The urine osmolality test would provide insight into the kidneys' ability to concentrate or dilute urine properly, further informing management of the fluid volume deficit. The patient's frequent urinary tract infections (UTIs) over the past two years and current presentation also point towards compromised kidney function, making it the priority issue.