Question

A 74-year-old woman who lives alone, is admitted to the hospital because of weakness and confusion. She has a history of chronic heart failure and chronic diuretic use. She states she takes a "water pill" every day but is unable to recall the name or dose of the medication. She also is unsure of what time she takes it or how often. Neurologic: confusion, slow to respond to questions, generalized weakness Cardiovascular: blood pressure 94/68, HR 128 and irregular, peripheral pulse is weak Pulmonary: respiration 26 per minute and shallow Additional findings: decreased skin turgor and dry mucous membranes Na 141 mg/L K+2.5 mg/L CI-85 mg/L BUN 42 mg/dL O Arterial Blood Gas: pH=7.1, Paco2=55, PaO2-88, 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? Discuss the role of aldosterone in the regulation of fluid and electrolytes balance. How will changes in aldosterone affect this patient's fluid and electrolyte imbalances? What other information would be important for the nurse to know about this patient in order to provide adequate care? What other lab tests would be indicated and why?

what diagnostic tests would be indicated, if any , and what would be the plan of care for this patient while in the hospital

Answer 1

1, There is low potassium level in the lab test. The patient has hypokalemia. potassium level below 3.5MEq/l considered hypokalemia.
2, Hypokalemia associated with any muscular or cardiac dysfunction. patient generalized weakness and confusion indicate there is a low potassium level in the blood.
3, low potassium level, patient PH less than 7.35, elevated paco2 indicate respiratory acidosis. patient shallow breathing, low respiratory rate, low blood pressure, confusion associated with respiratory acidosis. patient generalized weakness can affect patient breathing it can decrease patient pH level.
4, Most reasonable etiology for imbalance, respiratory acidosis caused by chronic diuretics use. diuretics increase sodium delivery to the distal segment of distal tubules, it increases the potassium loss and causes hypokalemia. diuretics increase the urine output it makes the patient dehydrated. when there are high sodium reabsorption and exchange of potassium and hydrogen ion lost through urine. Diuretics decrease blood volume and venous flow. so that the patient had high heart rate and weak pulse, low blood pressure. There will be low ventricular stroke volume and arterial pressure and cardiac output due to long term use of diuretics.
5, Loss of potassium and hydrogen ion by diuretics there is a renin-angiotensin-aldosterone system that will be activated it causes low blood volume and aterial pressure, due to high aldosterone stimulation there is a sodium reabsorption and high potassium and hydrogen ion excretion through urine which causes hypokalemia.