Question

tt N.A. is brought to the ED for management of intentional drug overdose. He ingested 56 tables of Amoxicillin (prescribed 875 mg po BID for 28 days for a sinus infection) and 30 tablets of Seconal (prescribed 100 mg capsules po QHS prn for sleep). His respirations are slow and shallow, and he is non-responsive. He is admitted to the critical care unit to be closely monitored for the development of ventilatory failure and renal failure, which often accompany drug overdose of Amoxicillin (renal failure) and secondary (ventilatory failure). His urine output is decreased at about 20 mL/hr. His laboratory values and serum K+ = 6.7 mEq/L; arterial blood gas: pH = 7.13, PaCO2 = 65 mm Hg; PaO2 = 88 mm Hg, and HCO3- = 16 mEq/L.

1. What is the most likely cause of N.A.'s potassium imbalance? Explain the role of the kidney in potassium excretion.  (2 points)

2. What is the relationship between acid-base balance and serum potassium level? (2 points)

3. What is the reason for N.A.'s low urine output? How should his fluids be managed?

(2 points)

4. Categorize and explain the probable cause of N.A.'s acid-base disorder.  (2 points)

5. Can N.A. compensate for his acid-base disorder? Why or why not? (2 points)

6. How should his acid-base imbalance be medically managed? What is your rationale for each interventions?   (2 points)

7. List two nursing diagnoses and one spiritual nursing diagnoses for N.A.  (3 points)

Answer 1

1, Amoxillin overdose is the main cause of N.As potassium imbalance. amoxicillin overdose causes renal failure that leads to potassium imbalance due to decreased urine output.
Potassium filtered by glomerulus filtration and excreted through urine. when there is impaired kidney function potassium can not be excreted from the body it causes a potassium imbalance.
2, Acidemia(less PH) associated with high plasma potassium concentration if there is Alkalemia there is reduced potassium concentration.
3, Amoxicillin overdose cause drug toxicity and cause renal failure. due to low urine output, there is severe dehydration.
IV fluids therapy can be useful to replace the electrolytes and it excretes the potassium concentration through urine.
4, Respiratory acidosis
PH level is less than 7.35(less )
Paco2 high 65mmofHg(high) due to high carbon dioxide cause ventilation failure and increase the partial pressure of arterial carbon dioxide(paco2(hypercapnia)
this is due to sedative overdose(seconal) causes hypopnea syndrome and causes hypoventilation and respiratory acidosis.