Question

Case Study: Fluid and Electrolyte Imbalances- Chapter 39

Mr. Abdul is a 76-year-old male who has been admitted to the hospital with a diagnosis of congestive heart failure (CHF). He complains of being tired all the time and barely having enough energy to sit up sometimes. “I think I've put on some weight. My waistband and shoes seem to be tighter and more uncomfortable to wear.” He has a history of coronary artery disease. He has smoked one pack of cigarettes per day for 56 years. He has no known drug allergies (NKDA) and has full code status.

Mr. Abdul's vital signs on admission are T 36.5° C (97.7° F), P 118 regular and bounding, R 32 and labored, BP 160/100, with a pulse oximetry reading of 90% on room air. He denies pain and is alert and oriented to person, place, time, and event. He can move all extremities easily but requires assistance with activities of daily living (ADLs) such as bathing and dressing, He becomes short of breath on exertion. He has fine crackles throughout all lung fields and has a moist, nonproductive cough. Bowel sounds are active in all four quadrants. The last bowel movement, a formed brown stool, was yesterday. His skin is warm, dry, and slightly pale. He has +3 pitting edema in both ankles and +1 bilateral dorsalis pedis and posterior tibial pulses. Admission laboratory test results are as follows:

• Electrolytes: sodium 142 mEq/L; potassium 3.3 mEq/L; chloride 100 mEq/L; bicarbonate 29 mEq/L; blood urea nitrogen 18 mg/dL; creatinine 0.8 mg/dL; glucose 140 mg/dL

Complete blood count: hemoglobin 15 g/dL; hematocrit 45%; white blood cells 8000 mm3; platelets 300,000 mm3

• Arterial blood gases: pH 7.34; PCO2 56 mm Hg; bicarbonate 32 mEq/L; PO2 80 mm Hg; O2 saturation 90%.

Medications are as follows:

• Digoxin 0.125 mg PO q A.M.

• Furosemide 80 mg IV now, then Lasix 40 mg PO q A.M. beginning tomorrow

Treatment orders are as

• O2 2 L/min per nasal cannula

• Vital signs q 4 hr. with pulse oximetry

• Daily weight

• Strict intake and output

• Diet: no added salt

• Activity: bed rest

• Saline lock

1. The major electrolytes in the body are sodium, potassium, calcium, magnesium, chloride, and phosphate.

a. Indicate the normal levels for each electrolyte and describe the function of each

b. What are food sources for each electrolyte

2. Describe the two common fluid imbalances and describe each.

a. Include the underlying causes, clinical manifestations

b. What fluid imbalance Mr. Abdul is experiencing. Describe his signs and symptoms.

3. Describe common electrolyte imbalances and their signs and symptoms.

a. Describe the nursing intervention for each electrolyte imbalance

4. What lab result would Kathy want to communicate to Mr. Abdul’s primary care provider (PCP) immediately so orders can be obtained to correct the imbalance? Give your rationale for your choice.

A. His serum sodium level

B. His serum potassium level

C. His serum chloride level

D. His serum bicarbonate level

Answer 1

1.

Electrolyte	a.Normal values	b. Function &	Food source
Sodium	135_145mEq/L	to maintain blood pressure Fluid balance Transport nutrients Proper nerve and muscle function	All salted food items Breads Poultry Shrimp Soup
Potassium	3.5_5mEq/L	Fluid balance Nerve functions For muscle contraction	fruits (banana,Apple, raisins ) Vegetables Green leafy vegetables Salmon,Sardines, cod
Calcium	8.5 _10.5mg/dl	muscle contraction Activation of oocytes in female Nerve functions Fluid balance Good skeletal functions Strong teeth	Dairy products Broccoli Ketu Soya beans Soya drinks Fish bones
Magnesium	1.5_2.5mEq/L	Bone strength Nerve function Muscle function Fighting infection Cardiac function	Wheat Spinach Almonds Huts Legumes Tofu Fush
Chloride	96_106mEq/L	Fluid balance Digestion	Tomatoes Cauliflower Broccoli Potatoes Peppers Cabbage
Phosphate	2.5_4.5mg/dl	Nerve functions Muscle contractions Bones health Avid base balance	Grains Meat,organ meat Chicken Fish products Nuts Grsins

2.The common fluid imbance are acidosis or alkalosis

In General these are termed to be Respiratory(acidosis/alkolosis) and metabolic (acidosis/alkolosis )

Causes:

• Fluid loss
• Fluid retention
• Heart failure
• Lung failure
• Kidney failure
• Metabolic disorder

Signs and symptoms

Acidosis:confusion ,fatigue,headache,anorexia,tachycardia,tachypnea, anorexia,tremor

Alkolosis :Muscle twitching,confusion,nausea,vomiting, numbness,tremor, coma,dizziness

b. The patient is experiencing acid base imbalance (chronic respiratory acidosis (decreased pH,elevated bicarbonate and CO2)

His signs and symptoms are

• Tachycardia (118)
• Tachypnea (32)
• Breathing difficulties
• Edema of ankle ,bilateral dorsalis pedis and posterior tribal pulse

3.The common electrolyte imbalance are

• Sodium
  • Hyponatremia:headache,confusion,muscle twitching, loss of conscious, decreased alertness, dizziness ,nausea
  • Hypernatremia :dehydration,thirst,irritability ,seizure,coma,lethargy
• Potassium
  • Hypokalemia:weakness,fatigue,breathing difficulties, palpitations, altered sensorium,
  • Hyperkalemia:Muscle twitching ,weakness, nausea,slow heart beat and breathinh

4.The potassium level are below normal ,so it has to be corrected immediately to prevent work tension on heart and other vital organs and functions

Bicarbonate are elevated so it has to be reduced to orevent complications