Scenario : a post-op mastectomy patient

Scenario : a post-op mastectomy patient

Mrs N is one day post-op mastectomy.  She has a Jackson Pratt drain to the affected side.  She is on a clear liquid diet.  She has an IV of LR running at 75 mL/hr.  In the last 12 hour shift (7a-7p), for breakfast, Mrs N consumed 5 oz of coffee and 1 cup of clear broth.  Mrs N voided 575mL in the bedside commode hat.  At 0900 Mrs N. consumed 150mL with her morning medications.  At 1130 the CNA assisted Mrs N to the bedside commode for a void of 500mL.  For lunch Mrs N consumed 4 oz of milk with her clear broth.  She only consumed 1/3 cup of the soup.  At 1430 Mrs N voided 580mL clear yellow urine in the bedside commode hat.  For dinner Mrs N consumed 1 ½ cups of jello and ¾ cups of clear broth.  At 1640 Mrs N voids 360mL. At 1815 the nurse empties 150mL of serosangeunous fluid from the JP drain and re-sets the drain.

1. What is the intake for the 12 hour shift?
2. What is the output for the 12 hour shift?
3. What is the fluid balance for the 12 hour shift (Include sign and volume)?
4. In your nursing judgment is the fluid balance appropriate; why?
5. What is wrong with Mrs N’s noon meal?
6. Define or describe serosanguenous fluid.

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