A nurse is caring for a laboring client at 37 weeks gestation who has severe preeclampsia.… — NCLEX-RN

A nurse is caring for a laboring client at 37 weeks gestation who has severe preeclampsia. The provider has prescribed a strict total fluid restriction of $125\text{ mL/hr}$ , which includes all oral and intravenous (IV) intake.

The client is receiving a continuous IV infusion of magnesium sulfate at a rate of $2\text{ g/hr}$ . The magnesium sulfate is supplied as $40\text{ g}$ in $1,000\text{ mL}$ of sterile water. The client also has a continuous IV infusion of oxytocin running at $15\text{ mL/hr}$ . Over the past 4 hours, the client has consumed $4\text{ oz}$ of ice chips and $120\text{ mL}$ of water.

Assuming the oral intake is distributed evenly across the 4 hours, what is the maximum rate in $\text{mL/hr}$ at which the nurse should program the primary IV pump to deliver lactated Ringer's solution? (Record your answer as a whole number.)

Cevap: 15 mL/hr

Cevap

Clients with severe preeclampsia are at high risk for pulmonary edema and require strict fluid restriction, typically limited to

125\text{ mL/hr}

from all sources. To calculate the remaining allowable fluid for the primary IV, the nurse must sum all current hourly intakes and subtract this from the

125\text{ mL/hr}

limit.

First, calculate the magnesium sulfate rate:

40\text{ g}

1,000\text{ mL}

yields a concentration of

0.04\text{ g/mL}

. The prescribed rate is

2\text{ g/hr}

, which requires

50\text{ mL/hr}

(

2 \div 0.04

).

Second, determine the hourly oral intake. The client consumed

4\text{ oz}

of ice chips, which equals

120\text{ mL}

. Because ice chips melt to half their volume, this counts as

60\text{ mL}

of intake. Added to the

120\text{ mL}

of water, the total oral intake is

180\text{ mL}

over 4 hours, resulting in an average of

45\text{ mL/hr}

.

The total current intake is

50\text{ mL/hr}

(magnesium) +

15\text{ mL/hr}

(oxytocin) +

45\text{ mL/hr}

(oral fluids) =

110\text{ mL/hr}

.

Finally, subtract this from the restriction limit:

125\text{ mL/hr} - 110\text{ mL/hr} = 15\text{ mL/hr}

. The primary IV should be set at a maximum of

15\text{ mL/hr}

Adım Adım Çözüm

Calculate the IV rate for the magnesium sulfate infusion.

50\text{ mL/hr}

The concentration is

40\text{ g}

1,000\text{ mL}

(or

0.04\text{ g/mL}

). The prescribed dose is

2\text{ g/hr}

. Therefore,

2\text{ g/hr} \div 0.04\text{ g/mL} = 50\text{ mL/hr}

Calculate the total volume of oral intake over the 4-hour period.

180\text{ mL}

Standard conversion:

1\text{ oz} = 30\text{ mL}

4\text{ oz}

of ice chips =

120\text{ mL}

. Ice chips melt to half their volume, providing

60\text{ mL}

of fluid. Adding the

120\text{ mL}

of water gives a total of

180\text{ mL}

(

60\text{ mL} + 120\text{ mL}

Calculate the average hourly oral intake.

45\text{ mL/hr}

The

180\text{ mL}

of oral intake was consumed over 4 hours.

180\text{ mL} \div 4\text{ hr} = 45\text{ mL/hr}

Calculate the total current hourly fluid intake.

110\text{ mL/hr}

Add the rates of all current intake sources:

50\text{ mL/hr}

(magnesium) +

15\text{ mL/hr}

(oxytocin) +

45\text{ mL/hr}

(oral fluids) =

110\text{ mL/hr}

Determine the maximum rate for the primary IV lactated Ringer's.

15\text{ mL/hr}

Subtract the current total intake from the strict restriction limit:

125\text{ mL/hr} - 110\text{ mL/hr} = 15\text{ mL/hr}

Anahtar Kavram

Fluid Volume Calculation and Restriction Management in Preeclampsia

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