Question

A 60-year-old present to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies. Assessment Findings: Neurologic: Fatigue, generalized weakness Cardiovascular: blood pressure 160/88, HR 104 and irregular, peripheral pulse is weak Pulmonary: Difficulty breathing at rest, respiration 24 per minute and shallow, 02 sat 90% Additional findings: bilateral low extremity edema Significant laboratory results: Na 129 mEa/L K+4.9mEc/L Cl-88 mEc/L BUN 38 mg/dL Arterial Blood Gas: pH 7.5, PaCO2= 27, HCO3= 21 Describe the patient's electrolyte status. Which electrolyte imbalance does the patient have? What physical assessment findings support your analysis? Which laboratory results support your analysis What is the most likely etiology of these imbalances? The ED physician orders IV fluids for this patient. Which type of fluid would be most appropriate for this patient? Explain your rationale for the above fluid choice. What other information would be important for the nurse to know about this patient in order to provide Olequate care?

Answer 1

1.Patient has hyponatremia.which is because of lower serum sodium levels normal is 135 -145 meq/litre .

2.physical assessment of generalized weakness and fatigue shows because hyponatremia can be caused due to low water level that is hypovolemia,normal water level but high sodium in blood ,and hypervolemia which increases the dilution and thus lower serum sodium .and peripheral edema is also a sign of hyponatremia caused due to hypervolemia when the intracellular fluid shift to extracellular space leading to edema

3. Serum sodium levels of 129 meq/litres shows that the patient has hyponatremia

4.etiology of hyponatremia hyponatremia is mostly caused because of adrenal insufficiency,congestive heart failure,lower food intake and fluid intake,diarrhoea ,vomiting,cirrhosis of liver,SIADH.

5.since the serum sodium is only moderately low 129.a rapid correction may not be needed and considering peripheral edema fluid also should be restricted so the fluid of choice is infusing 100ml 3%saline hypertonic saline over a span of 6 hours which will correct the sodium slowly.

6.The nurse should be aware about the family history of IHD and her history of smoking which can risk her to have heart disease so this information can help the nurse to screen the patient for signs of heart disease as potassium is also borderline .she can also check the patients lipid profile,2 d echo to check the heart function.