Question

You are assigned to care for a 65-year-old woman admitted last evening with a recent history of cellulitis and a 3-day history of persistent vomiting and diarrhea. She takes no medications at home, other than a daily multivitamin. Her weight on admission was 153 pounds. The patient states her original weight is 165 pounds (75 kg). The nurse notes that the patient’s mucous membranes and skin are dry. Vital signs are temperature 99.8° F, pulse 112, respirations 32, and blood pressure 100/76. Her urine output over the last 8 hours is 125 mL with a specific gravity of 1.033. Morning labs reveal serum K+ 3.5 mEq/L; Na+ 159 mEq/L; and Cl- 120 mEq/ L. Her hematocrit and BUN were elevated. Serum glucose was 163 mg/ dl. Her ABG results were: pH of 7.30, HCO₃ 17 mEq/L, PaCO2 of 28, PaO2 of 88.

1. The nurse assesses the patient’s body fluid state. Name four of her symptoms and laboratory findings that are suggestive of the fluid imbalance (dehydration).
2. Which type of hypernatremia is the patient experiencing (water loss or sodium gain)?
3. This patient’s symptoms are most likely a result of which acid-base imbalance? Explain the rationale for your response.
4. The bicarbonate level of 17 mEq/L is the result of which factor?
5. Which ABG finding indicates a worsening acid-base imbalance?
6. What priority nursing and collaborative interventions do you anticipate for this patient?

Answer 1

1. ANS: Patient had been vomiting and episodes of diarrhea the last 3 days. Weight loss, Mucous membranes are dry, Low urine output.

2. ANS: Water loss, related to the weight loss, dry mucous membranes, decreased urine output, excessive vomiting and diarrhea, and urine specific gravity greater than 1.030. (Saunders, 2013)

3. ANS: Uncompensated metabolic acidosis, both ph and HCO3 are in the acid ranges; the CO2 is within normal range and is doing nothing to compensate for the imbalances. (Saunders, 2013)

4. ANS: The bicarbonate level of 17 mEq/L is the result of over elimination of bicarbonate.

5. ANS: The decreasing PH levels indicates a worsening acid-base imbalance

6. ANS: IV hydration, anti diarrheal, insulin to treat DKA, and administering bicarbonate

Reference: Saunders, 2013. Unit 4 -Assessment and Care of Patients with Fluid and Electrolyte Imbalances. [Power Point Slides}.

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