An elderly patient is hospitalized with marked lethargy. Laboratory findings show a hematocrit of 54% and a sodium level of 120 mmol/L. Which intervention should the practical nurse anticipate implementing first?

An elderly patient is hospitalized with marked lethargy. Laboratory findings show a hematocrit of 54% and a sodium level of 120 mmol/L. Which intervention should the practical nurse anticipate implementing first?

• A. Pushing oral fluids
• B. Establishing an intravenous (IV) line of 10% dextrose solution
• C. Starting an IV line of normal saline (0.9% NaCl)
• D. Inserting a nasogastric tube for enteral feeding

Answer: (C)

The situation shows dehydration with hyponatremia. The elevated hematocrit indicates reduced circulating volume, and the low sodium suggests a volume-depleted state that can cause CNS symptoms like lethargy. The first priority is to restore intravascular volume and begin correcting the sodium with isotonic fluid. Starting an IV line with normal saline provides volume expansion and helps increase the serum sodium gradually in a controlled way, addressing both problems at once. Giving oral fluids isn’t ideal here because the patient is lethargic and at risk for aspiration, and it wouldn’t rapidly correct the intravascular volume deficit. A 10% dextrose solution would introduce free water as it’s metabolized, which can worsen hyponatremia. Inserting a nasogastric tube for feeding doesn’t address the acute volume or electrolyte disturbance. The IV normal saline approach is the most appropriate first step to treat the underlying issues safely and promptly.

The situation shows dehydration with hyponatremia. The elevated hematocrit indicates reduced circulating volume, and the low sodium suggests a volume-depleted state that can cause CNS symptoms like lethargy. The first priority is to restore intravascular volume and begin correcting the sodium with isotonic fluid. Starting an IV line with normal saline provides volume expansion and helps increase the serum sodium gradually in a controlled way, addressing both problems at once.

Giving oral fluids isn’t ideal here because the patient is lethargic and at risk for aspiration, and it wouldn’t rapidly correct the intravascular volume deficit. A 10% dextrose solution would introduce free water as it’s metabolized, which can worsen hyponatremia. Inserting a nasogastric tube for feeding doesn’t address the acute volume or electrolyte disturbance. The IV normal saline approach is the most appropriate first step to treat the underlying issues safely and promptly.