Question

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: • • Neurologic: confusion, slow to respond to questioning generalized weakness Cardiovascular: blood pressure 90/62, heart rate 112 and irregular, peripheral pulse is weak, ECG indicates sinus tachycardia Pulmonary: respiration 12 per minute and shallow Additional findings: decreased skin turgor and dry mucous membranes Significant Laboratory Results: Serum Electrolytes: Na+ 141mEq/L K+ 2.5 mEL Cl- 85 mg/l HCO3 - 43mEq/1 BUN 42mg/dl (15mmol/L) Arterial Blood Gas: pH: 7.52: PaCO2: 55mmHg: PaO2: 88mmHg: HCO3: 42mEq/L Critical Thinking Questions: 1) What is patient's volume status? 2) Which physical assessment and laboratory findings support your analysis? 3) Please discuss each physical assessment finding identified in 82 and explain the mechanism that caused each one. 4) Why has Kathleen's advanced age places her at risk for her fluid imbalance? 5) What is her acid base balance? 6) Discuss the values of her ABG and how these support your diagnosis.

Answer 1

1.Volume status

The patient has a fluid volume depletion or fluid volume deficit

2.The assessment which helps to do the analysis are

Physical:

• Decreased skin turgor
• Dry mucous membrane
• generalized weakness
• Shallow breathing
• Hypotension
• Weak pulse
• Confusion
• Tachycardia

Laboratory

• Increased BUN levels
• Decreased potassium levels

3.When there is continuous loss 9f fluid rae there is fluid depletion, the circulatory system first faces trouble in order to increase the function the heart beats faster resulting in tachycardia or increased heart rate,the compensatory mechanism is initiated .The loss of plasma fluids alters the electrolyte levels and the potassium from the intravascular cells are pushed out resulting in hypokalemia. This decrease the blood pressure leading to weakness ,fatigue .The fluid imbalance alters the acid base balance of the body usually resulting in metabolic alkalosis by increased pH,increased bicarbonate and increased pCo2 levels .Compensated respiratory acidosis simultaneously. This affects the renal system and leads to elevated blood urea nitrogen level.

4.The advancing age can lead to decreased renal function, decreased metabolism rate ,use of diuretics can pose an aged person at risk for fluid volume imbalances