Question

Case Study, Chapter 8, Disorders of Fluid, Electrolyte, and Acid–Base Balance

A nurse has just been assigned to care for three patients: A, B, and C. Selected lab work for each patient is listed below.

	Patient A	Patient B	Patient C
Na+	138 mEq/L	142 mEq/L	148 mEq/L
K+	5.1 mEq/L	6.1 mEq/L	3.8 mEq/L
Ca+	8.9 mg/dL	7.5 mg/dL	9.5 mg/dL
Mg+	1.3 mg/dL	0.9 mg/dL	2.1 mg/dL
pH	7.40	7.32	7.42
PCO2	42 mm Hg	48 mm Hg	40 mm Hg
PO2	95%	98%	99%
HCO3	22	28	26

(Learning Objectives: 13–16, 19–22, 32, and 33)

1. Which patient needs to be assessed first based on the information above? Why?

2. What could be some possible causes of the hyperkalemia?
3. Patient B is also complaining of numbness and tingling, especially around the mouth. What are the other two electrolyte imbalances in this patient that could be causing these symptoms?
4. Discuss the possible etiology associated with each electrolyte imbalance identified in question number 3
5. What manifestations are associated with the three electrolyte imbalances in Patient B?
6. How would you interpret Patient B’s arterial blood gases?
7. What body system will attempt to compensate?

Case Study, Chapter 23, Disorders of Ventilation and Gas Exchange

The nurse is working in the emergency department when the paramedics call in and report that they are in route with Mr. T, who was involved in a motor vehicle accident. He is presently unconscious and receiving supplemental oxygen. Vital signs are BP, 110/68; HR, 100; RR, 10; and shallow, T. 98°F. (Learning Objectives: 8, 9, 10, and 11)

1. What additional information will be helpful? (Wajid Ahmed)

Mr. T was the driver, and he was wearing a seatbelt. His compact car collided head-on with a full-size pickup truck. There was no evidence of alcohol or drug involvement, and the only history that can be obtained is that he has a chronic lung problem.

2. Why would the nurse need to obtain more information about his lung problem?
3. Assessment reveals absent breath sounds on the right side with minimal chest movement. What does the nurse suspect and why?

A chest tube was inserted, and Mr. T was placed on a ventilator. He also sustained a significant head injury that has left him unconscious and in need of ventilator support. Several days later, he starts to regain consciousness and becomes extremely restless. When the nurse suctions his artificial airway, the nurse observes blood-tinged sputum. Mr. T has a low-grade fever and is tachycardic.

4. What does the nurse suspect and why?
5. How would a pulmonary embolus be diagnosed?

A diagnosis of pulmonary embolus was confirmed, and Mr. T was given streptokinase and started on heparin.

6. What are the nurse’s concerns related to this therapy?

The next day, the nurse notices that Mr. T has marked hypoxemia, which is not responding to increased levels of oxygen. A chest x-ray is obtained, which reveals diffuse bilateral infiltrates. He is diagnosed with ALI/ARDS.

7. What is the pathophysiology associated with ALI/ARDS?

Answer 1

Case study :Chapter 8

●The patient who has an elevated serum potassium level has to be assessed first.This can alter the cardiac function and cause fatal effects ,so it has to be balanced before the patient lands up in complications

●Some of the possible cause of hyperkalemia are

• Increased dietary intake
• Kidney disease
• Fluid loss
• Addison's disease
• Diabetes

● The other two electrolyte which is causing the symptoms are hypocalcemia(8.5_10.5mg/dl) and hypomagnesimia (1.7_2.2mg/dl)

●Hypocalcemia

• Renal disease
• Decreased magnesium, vitamin D
• Calcium malabsorption
• Increased phosphate
• Hungry bone syndrome

Hypomagnesemia

• Malabsorption
• Decreased intake
• Renal disease
• Decreased calcium

●Manifestations

Hyperkalemia	Hypomagnesemia	Hypocalcemia
Nausea Vomiting Weakness Fatigue Arrhythmia Chest pain Numbness Heart attack Numbness Death	Nausea Vomiting Muscle twitching Weakness Tremor Fatigue Increased blood pressure Paresthesia Seizure	Confusion Tingling Muscle weakness Cramps Numbness or tingling sensation around oral cavity Tingling in the finger tips Confusion

●The decreased pH refers to acidosis, Increased bicarbonate and CO2 level indicates metabolic changes.Hence patient B is experiencing metabolic acidosis

●The buffer system helps to compensate the acid base balance in the patient.