A 23-year-old ballet dancer arrived at the Emergency Department after collapsing

Question

A 23-year-old ballet dancer arrived at the Emergency Department after collapsing during a week of strenuous rehearsals for an upcoming production. The patient reported that she had been in good health and takes no medication except the occasional loratadine (Claritin) for her seasonal allergies. Further questioning revealed that the patient “lives on” diet colas to keep her weight down for dancing; she said she does not like the “taste” of water. Assessment in the Emergency Department revealed the patient to have a pulse of 140, blood pressure of 78/62 and poor skin turgor. She required aggressive intravenous fluid resuscitation.

Identify the contributing factors that led to her collapse. Assign one (1) nursing diagnosis along with an etiology and the defining characteristic(s). What is the significance of her pulse and blood pressure readings? What type of IV therapy might be used to restore this patient’s fluid balance? What other interventions do you think might be ordered for this patient? What nurse-patient teaching will likely be needed? Consider the evaluative criteria (outcome) used to determine if the therapy successfully restored fluid balance.

Explanation / Answer

1. As the dancer was totally on diet colas from a long time, she was literally dependent on the calories from the cola. She was suffering from low blood pressure as measured by her blood pressure. Abnormally high heart rate is one of the symptoms of low blood pressure. Poor skin turgor gives an indication that she has been completely dehydrated due to the lack of water intake.

Her pulse and blood pressure indicate her low blood pressure.

Correct fluid and electrolyte balance is essential to maintain normal physiological function. Hospitalised patients may not be able to eat and drink normally and often have depleted fluid levels and/or an electrolyte imbalance. Intravenous provision of fluid and electrolytes is therefore often needed to maintain or restore balance.

The three elements to assessing fluid balance and hydration status are: clinical assessment, body weight and urine output; review of fluid balance charts; and review of blood chemistry

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