Question

CASE STUDY: THE PATIENT WITH ACID-BASE IMBALANCE Use a separate sheet of paper to answer the questions in this Case Stüdy or go to the Prepare for Class folder on your Hvolve website at httillevolve sevier.com/ to download and complete as a word processing file. A wer guldelines for this case Study are also available on your Evolve website. A 40-year-old male is admitted to the hospital with report of severe abdominal pain. The patient has facial grimacing and moans occasionally during the nursing assessment. 2: 22 vital signs are: blood pressure 80/47 mm He, supine in right arm heart rate 1171 min; respirations 26/min, slightly dyspneic at restpulse oximeter reading 92% ter being placed on 100% O, via facemask. Lunes auscultated: clear upper lobes anterior and posterior, with few crackles in base anterior and posterior No productive cough is noted. There is no report of shortness of breath. The patient denies smoking presently and has no smoking history. There is trace edema of the ankles bilaterally, but there is no edema of the arms or trunk of the body. . A Foley catheter is put in place and in the past 5 hours there is a total output of 110 mL of amber, clear urine. The patient says he has vomited 1 to 2 times in the last 2 days and has had no bowel movement in the last 3 days; he normally has bowel movement daily. Auscultation of the abdomen reveals hypoactive bowel sounds. The skin is intact, slightly moist and pale, with no rash or wounds. The patient is alert and oriented to person, place, and time. He can move all extremi ties and can follow simple commands The patient's laboratory results are as follows: Arterial blood gas pH 7.29 Pao, 78 Paco, 36 HCO, 23 mEq/L WBC 20/mm Hgb 11.7 g/dL Het 38% Blood glucose 373 mg/dL Na 137 mEq/L Ca 8.7 mg/dL. Lipase 117 units/L Alanine aminotransferase 90 International Units/L • Amylase 203 International Units/L. 1. What are the top four body systems important to focus on in this patient's assessment? 2. Document a nursing note using the body systems identified in question 1. 3. What likely is the disease process of the patient? 14. What laboratory values indicate the medical condition of the patient? 30

Answer 1

1, Digestive system, urinary system, neurological system, and respiratory system.
2, Digestive system - due to vomiting 1 to 2 times, no bowel movement in the last 3 days, severe abdomen pain, high ALT and amylase level which involve pancreas and liver involvement, endocrine involvement cause high blood glucose level.
Urinary system - trace edema of the ankle bilaterally
Respiratory system- mild dyspnea, o2 sat 92% with 100% via facemask, few crackles in the base of the anterior and posterior.
Neurological system- facial grimacing and moans.
3, Low pH and high paco2 indicate metabolic acidosis, high ALT and amylase indicate pancreas and liver disorder due to high enzyme level, high WBC indicates infection, low Hct indicate mild anemic, high blood glucose indicate the patient is in process of diabetic ketoacidosis.
4, Elevated pancreas and liver enzymes(high ALT and amylase) and high blood glucose value greater than 250mg/dl, less pH, less Hco3 level indicate there is a process of diabetic ketoacidosis.