A client who has been diagnosed with mild hyponatremia and has experienced gastric fluid loss from vomiting is about to receive Half Normal Saline (0.45% NaCl).
This intravenous fluid contains Sodium 77 mEq/L and Chloride 77 mEq/L.
It is contraindicated in cases of hypovolemia, hyponatremia, increased intracranial pressure, liver disease, trauma, and burns.
What should the client say to demonstrate understanding of the treatment plan?

Choice A rationale:

“This fluid will help to increase your sodium levels which are currently too low.”.

The nurse should explain to the client that they are receiving Normal Saline (0.9% NaCl) to increase their sodium levels.

This is The correct choice because Normal Saline is a hypertonic solution containing 154 mEq/L of sodium and 154 mEq/L of chloride.

It is used in cases of hyponatremia to raise sodium levels.

Sodium is an essential electrolyte, and low levels can lead to symptoms such as weakness, confusion, and muscle cramps.

Choice B rationale:

“This fluid will help to decrease your sodium levels which are currently too high.”.

Normal Saline is a hypertonic solution that would not be used to lower sodium levels, as it would have the opposite effect and further elevate sodium levels.

Choice C rationale:

“This fluid will help to increase your potassium levels which are currently too low.”.

It is not used to increase potassium levels, and potassium replacement would require a different solution, such as potassium chloride.

Choice D rationale:

“This fluid will help to decrease your potassium levels which are currently too high.”.

Normal Saline does not address high potassium levels; it is used to address hyponatremia and dehydration by increasing sodium levels.

The correct answer is Choice B: Total maintenance fluids = 1200 mL/day.

Choice A rationale:

This value exceeds the calculated requirement for a child weighing 18 kg using the Holliday-Segar method.

Choice B rationale:

The Holliday-Segar method calculates maintenance fluids based on weight as follows:

• For the first 10 kg, the requirement is 100 mL/kg.
• For the next 10 kg, the requirement is 50 mL/kg.

Thus, for a child weighing 18 kg:

• First 10 kg: 10 kg x 100 mL/kg = 1000 mL
• Next 8 kg: 8 kg x 50 mL/kg = 400 mL Total maintenance fluid requirement = 1000 mL + 400 mL = 1400 mL/day.

So, actually, the correct answer should be Choice D: 1400 mL/day.

Choice C rationale:

This value is higher than the requirement for 18 kg based on the Holliday-Segar method.

Choice D rationale:

This is the correct calculation based on the method described above: 1000 mL for the first 10 kg plus 400 mL for the next 8 kg totals 1400 mL/day.