Question

BALEN CASE STUDY: THE PATIENT WITH UDY: THE PATIENT WITH ACID-BASE IMBALANCE Use separate sheet of paper to cover the questions in this Case Study or go to the repare for Class folder on your Evolve website at httlevolved.sevier.com/ for download and complete as a word processine file Answer quidelines for this Case uidelines for this case Shady are also available on your Evolve website. PA 10-year-old male is admitted to the hospital with a report of severe abdominal pain. The patient has facial grimacing and moans occasionally during the nursing assessment. Vital signs are: blood pressure 80/47 mm He, supine in right arm heart rate 1171 min; respirations 26/min, slightly dyspncic at rest: pulse oximeter reading 92% po after being placed on 100% , via facemask. Lungs auscultated: clear upper lobes anterior and posterior, with few crackles in bases 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 a 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 3. What likely is the disease process of the patient? 14. What laboratory values indicate the medical condition of the patient?

Answer 1

1, Digestive system
Respiratory system
Neurological system
Urinary system
2, Digestive system-vomiting 1to 2 times, no bowel movement in the last 3days, severe abdomen pain, elevated ALT and Amylase, high blood glucose level
Respiratory system - Mild dyspnea, o2 sat 92% with 100% via facemask, crackles in the base anterior and posterior
Urinary system - trace edema of the ankle bilaterally.
Neurological system - facial grimacing and moans.
3, Low pH and high paco2 indicate metabolic acidosis. High ALT and amylase(enzymes) indicate pancreas and liver abnormalities, high WBC indicates infection, low Hct indicate mild anemia, High blood glucose indicates the patient is in the process of Diabetic ketoacidosis.
4, Elevated pancreas and liver enzymes, high blood glucose value greater than 250mg/dl, low pH and Hco3 level showing the Diabetic ketoacidosis.