Question

Case Study: Dehydration Mrs. K.B. a 74-year-old woman who lives alone, is admitted to the hospital because of weakness and confusion. She has a history of chronic heart failure and chronic diuretic use. Objective Data: • Neurologie: confusion, slow to respond to questioning, generalized weakness • Cardiovascular: BP 90/62, HR 112 and irregular, peripheral pulses weak; ECG indicates sinus tachycardia • Respiratory: respirations 12 per minute & shallow • Integumentary: decreased skin turgor, dry mucous membranes Significant Laboratory Results: Serum Electrolytes: diuret N a+ 141 mEq/L 135-145megi not K+ 2.5 mEq/L 3.5-5.0m all Kidnes - BUN 42 mg/dl 6-20 mg jal furay.gh Het 49% e 540-417% Blood pressu • Arterial blood gases (ABGs) ↑ x pH 7.52 7.35-7.45 KPaCo255 mm Hg 34-45 breithng Shallow PaO288 mm Hg 3 Colomm H980-100 1 x HCO, 42 mEq/L 2000y ounge Critical Thinking Questions 19-25 meter 1. Evaluate Mrs. K.B.'s fluid volume and electrolyte status. 2. Which clinical manifestations support your analysis? 55 Ik-112. Periphead puses R2 RR waitness Controton slow to respond to questioning, tachycare 3. Which laboratory results support your analysis? Provide a rationale for each. kt- diuretic Bun, Hct, bw bucd presser nypo Kalemin 4. What is the most likely etiology of these imbalances? Potassium being low 5. What is the acid base imbalance? metabolic alkalosis 6. Is the body compensating for this imbalance? AD 7. Why has Mrs. K.B.'s advanced age place her at risk for her fluid imbalance?

Answer 1

1, Patient signs and symptoms indicate there is a severe fluid loss that leads to severe dehydration and potassium loss.
2, patient dry mucous membrane, weak peripheral pulse, shallow breathing, hypotension indicate there is severe dehydration, low potassium volume due to excess diuretic use.
3, Patient serum potassium level is low due to excess diuretic use that causes loss of fluid loss, high BUN level due to low blood flow to the kidney due to dehydration and diuretic use that make renal function low. Diuretic eliminates sodium and water through urine when chronic use of diuretics that cause hypokalemia. high Hct indicates there is severe dehydration when there is blood fluid volume drop it causes our body to make more RBC.
4, chronic diuretic causes potassium volume low that leads to renal failure that causes an alteration in fluid volume.
5, Patient PH is high, paco2 and Hco3 is high that indicate metabolic alkalosis.
6, when there is a fluid loss that causes metabolic alkalosis that leads to hypovolemia that increases Hco3 level. compensation happens through lungs and kidney, but patient breathing is shallow and kidney not functioning properly to bring the Ph level normal, so there is no compensation happening.
7, when aging progress there is high cortical glomerulosclerosis and reduce GFR and renal plasma flow happens. It causes low and high excretion of sodium, potassium, and urine. When aging progress there will be a cognitive disability that makes them with poor follow up medication and monitoring that causes an electrolyte imbalance that increases their chance for high risk with renal failure. As they are elder, they will not drink enough water to maintain their electrolyte balance that causes dehydration.