Question

A 37-year-old landscaper is brought to the ED after collapsing on a job at the local country club. He complained of nausea during the morning when the temperatures outside reached 99 degrees F. He told his employer he was reluctant to drink because he feared he might vomit. He arrives in the ED and is slightly confused but is able to tell you he feels dizzy and weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. He voided 60 ml. of dark, concentrated urine. Neurologic: confusion, dizziness, generalized weakness, complains of a headache Cardiovascular: blood pressure 90/62, HR 135 and irregular, peripheral pulse is weak Pulmonary: respiration 28 per minute and shallow Na 158 mg/L K+ 4.8 mEq/L CI-110 mg/L BUN 42 mg/dL Arterial Blood Gas: pH 7.2, PacO245, PaO2-90, HCO3 43 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. What types of fluids are indicated? Besides the IV fluids what other interventions are appropriate for the patient's electrolyte imbalance? Which acid-base imbalance is this patient suffering from? What is the treatment for this condition? What other lab or diagnostic tests would be indicated, if any.

describe discharge instruction for the patient

Answer 1

1.the patient is having hypernatremia as the serum sodium level is 158.

2.The assessment shows that the patient is having headache, nausea, confusion and concentrated urine due to water retention

3.Serum electrolyte level(serum sodium)

4.the etiology can be due to excessive sweating which causes dehydration, or any kidney disorder

5.Hypotonic iv fluids(0.45% Normal Saline or solution without sodium content ) are indicated as the patient is having hypernatremia

6.ask the patient to drink more water, restrict the salt intake, monitor for complications, monitor vital signs

7.partially compensated respiratory acidosis

8.treat the cause, noninvasive ventilation,increase the I:E ratio to wash out the CO₂, increase respiratory rate to wash out CO₂

9.other lab tests- renal function test to rule out acute kidney injury