Question

Answer the questions according to given case study-
Adam is a 68-year-old male admitted to the hospital with a 1-month history of nausea, vomiting, and diarrhea resulting in weight loss and fatigue. He presents tachycardic with abdominal pain, fever, and chills. Adam is a retired engineer and lives at home with his wife.

Anthropometric Data:
Height: 165 cm (65”)
Weight: 75 kg (165 lbs)
BMI: 27.5 kg/m2

Weight History
Usual body weight: 82 kg (180 lbs) 1 year ago

Biochemical Data:
Sodium 129 (135-145 mEq/L) Potassium 3.2 (3.6-5.0 mEq/L) Low-density lipoprotein 41 (Desirable <100 mg/dL)
Chloride 90 (98-110 mEq/L) High-density lipoprotein 52 (Desirable ≥40 mg/dL)
Carbon dioxide 43 (20-30 mEq/L) Triglycerides 40 (Desirable <150 mg/dL)
Blood urea nitrogen 30 (6-24 mg/dL) Hemoglobin 11.1 (13.5-17.5 mg/dL)
Creatinine 0.5 (0.4-1.3 mg/dL) Hematocrit 36.4 (42%-52%)
Glucose 166 (70-139 mg/dL) White blood cells 6 × 109 (5-10 × 109/L)
Magnesium 1.3 (1.3-2.1 mg/dL) Mean corpuscular volume 89 (80-99 fL)
Calcium 8.0 (8.5-10.5 mEq/L) Mean corpuscular hemoglobin concentration 32 (32-36 g/dL)
Phosphorus 2.7 (2.7-4.5 mg/dL) Red cell distribution width 50 (39-36 fL)
Serum osmolality 250 (275-295 mOsm/kg)
Albumin 2.6 (3.5-5.0 g/dL)

Clinical Data:
Past Medical History: Hypertension, hypercholesterolemia, hypertriglyceridemia, gastroeophageal reflux disease
Medications: Lipitor, Captopril, aspirin, Immodium, omeprazole
Vital Signs: Blood pressure 110/50 mm Hg, temperature 99.6° F, heart rate 115 beats/min,
tachycardic
Nutrition-focused Physical Exam: Patient noted to be pale with dry skin and poor skin turgor.
Temporal muscles mildly wasted. Upper arm and lower extremity fat loss evident. Abdomen appears
slightly distended. Oral exam notable for a dry tongue and good dentition. No wounds observed and
no edema noted. No shortness of breath evident.

Dietary Data:
Dietary History: Normal appetite. Adam reveals he has avoided high-fat foods for the past year, and
limits his sodium intake. He reports that he has had minimal intake for 3 to 4 days prior to admission.
Usual Diet Recall:
Breakfast: 8 oz orange juice, hard-boiled egg, 1/2 bagel with 2 oz cream cheese
Lunch: Sandwich with 3-4 oz turkey or ham and mustard on white bread, canned soup, 1 oz potato
chips, 1% milk, apple
Dinner: 4 oz baked chicken, 2/3 cup rice, ½ cup cooked green beans
Diet Prescription: NPO (nil per os or nothing by mouth)

Questions
1. Describe the possible pathophysiologic etiology associated with Adam’s electrolyte abnormalities.
2. What are Adam’s nutritional risk factors?
3. What additional information and labs would you like to obtain?
4. What are your priorities for this patient?

Answer 1

Q.no 1. Answer :

Electrolytes includes : here sodium 129 MEq/ lit, it is low.

Potassium 3.2 mEq/ lit it is low.

Chloride 90 mEq/ lit, low.

Magnesium 1.3 mg/ dl normal.

Calcium 8.0 mEq/ lit it is also low.

Phosphorus 2.7 mg / dl normal.

The pathophysiologic etiology including the Adam's having nausea, vomitings, and diarrhea since one month.

* that means there will be a loss of more body fluids and electrolytes through diarrhea and vomiting.

* there will be a flush out of all potassium, magnesium, sodium through the vomitings and diarrhea.

* and due to lack of fluids intake also there is a dehydration.

* and the demand may increases for electrolytes.

* alterations may comes in the blood and kidneys to maintain normal electrolyte balance.

Q. No 2. Answer :

Adam's nutritional risk factors :

* the client is taking less sodium it may cause hyponatremia.

* because now she is having only 129 mEq/ lit. It is low, so she has to take sodium containing diet.

* client was talking daily hard egg, chicken, cheese, sandwich, potato so, Adams already 68 years old, these all foods can't not digest property, because during in old age the digestive system function may decreases.

* so for older people soft diet is best always.

* so, there may be a risk due to what the diet client followed.

Q. No. 3 answer :

Additional information and labs :

* there is abdominal pain, vomitings, and fever in these situations we can suspect appendicitis,

* so we have to collect history like still more food habits like outside eating,

* for these we can advise client to ultrasound abdomen to rule out diagnosis.

* abdomen looks like slightly distended so, check for fluid accumulation in peritoneal cavities like Asitis.

* for this also we can advise ultrasound abdomen.

* corbondioxide also 43 mEq/ lit, so the ABG analysis must be need check acid base imbalance levels.

Q. No 4. Answer :

Priorities :

1. There is a severe dehydration so first intravenous fluids administration should be done. Along with some electrolytes like sodium chloride and potassium chloride and magnesium sulfate, calcium gluconate.

2. If we will administer the fluids may increases fluids volume and decreases the dehydration.

3. Fever and tachycardia also come down.

4. Then we need to provide ante emitics and anti diarrheal drugs.

5. Next antipyretics like paracetamol.

6. Comfortable calm and quiet environment.

7. Intake and out put chart maintaining.

8. If client can able to talk mouth give sips.

9. Or else put nasogastric tube to maintain nutritional levels.

10.provide emotional and psychological support.