Question

Patient Profile

E.G. is a 73-year-old woman whose daughter brings her to see the health care provider because she has had a case of the “stomach flu,” with vomiting and diarrhea for the past three to four days and is now experiencing occasional light-headedness and dizziness. Her past medical history includes hypertension, hypercholesterolemia, and mild heart failure. She is taking:

Digoxin 0.125 mg po daily.

Captopril 25 mg po BID.

Furosemide 40 mg po daily.

Potassium chloride 20 mEq po daily.

Atorvastatin 20 mg po at bedtime.

Subjective Data

Has been following a low sodium diet

States her abdomen feels bloated and she has been constipated since the onset of the “flu”

Has been taking her medications except for the potassium chloride pill because it upsets her stomach.

Occasionally takes an extra “water pill” when her ankles are swollen

Objective Data

Physical Examination

Temperature 98.2° F, pulse 88, respirations 20, BP 138/86

Lungs clear to auscultation, breathing regular and unlabored

+1 edema bilaterally in ankles

Muscle strength in upper extremities normal and equal and in lower extremities weak

Sensation to all extremities normal

Abdomen distended with hypoactive bowel sounds

Diagnostic Studies

Lab values

Sodium  139.0mEq/L

Potassium 3.0mEq/L

HCO₃^-  25.4mEq/L

Chloride  99.5 mEq/L

1. What diagnostic test is indicated and why?

2 Write three nursing diagnoses that are appropriate for E.G.

3. What interprofessional care would you anticipate for E.G.?

4. What instructions should you give E.G. regarding the signs and symptoms of this electrolyte imbalance and how to prevent it?

Answer 1

1=

1.Blood tests

• Check for anemia, thyroid problems ,high cholesterol and BNP (B type natriuretic peptide) which can indicate active heart failure .

2.Urine tests

• To look for kidney problems or diabetes

3.Ecg

• It can detect any arrhythmias,heart failure, cardiac hypertrophy

4.Echocardiogram

• To evaluate heart muscle function ,to see how well heart is pumping ,to evaluate heart valve, ejection fraction

5.stool culture to identify the causative organism

2=

1 fluid volume deficit related to prolonged diarrhea and vomiting

2 risk for electrolyte imbalance as evidence by hypokalemia

3 impaired skin integrity related to exposure to moisture and prolonged bed rest

A=monitor vital signs as well as central venous pressure if available

B=weigh client daily

C=monitor intake and output

D=encourage adequate bed rest

E=provide skin care

F=provide safety measures

• Bed in low position
• Frequent observation
• Soft restraints
• Use of side rails

G=monitor laboratory studies ,sodium ,potassium ,abg

H=electrolyte replacement

I=provide balanced protein, low sodium diet

J=administer diuretics as indicated

3=

Common symptoms of electrolyte imbalance is

• Irregular heartbeat
• Fatigue
• Lethargy
• Convulsions
• Nausea
• Vomiting
• Diarrhea or constipation
• Abdominal cramps
• Muscle weakness
• Irritability
• Confusion
• Headache
• Numbness and tingling

4=client instructions like

• Monitor fluid intake output ,teaching how to measure urine how to cocount or weigh diapers
• Educate the rational of regular body weight measurement weigh same time a day using same scale
• Educate family regarding the any significant changes in urine output ,weight ,episodes of prolonged vomiting diarrhea ,inability to eat and drink dry mucus membrain edema over fingers ,feet, ankles or leg. Breathing difficulty ,shortness of breath changes in behavior and mental status
• Monitor diet and fluid restrictions
• Teach family members regarding importants of regular fluid intake
• Teach importance of changing clients position slowly
• Importants of mouth and skin care
• Emphasize the importance of and rationale for taking medications as prescribed
• Instruct client regarding diuretics to take medication in the morning and second dose in late afternoon to avoid sleep disturbance
• Inform the client regarding side effects of drugs and how to handle them