Question

WEEK 3 ASSIGNMENT #1 Case Study, Chapter 8, Disorders of Fluid, Electrolyte, and Acid-Base Balance A nurse has just been assigned to care for three patients: A, B, and C. Selected lab work for each patient is listed below. Patient C Patient A Patient B 138 mEq/L 142 mEq/L K 5.1 mEq/L 6.1 mEq/L 8.9 mg/dL 7.5 mg/dL. Mg 1.3 mg/dL. 0.9 mg/dL 7.40 PCO2 42 mm Hg 48 mm Hg PO2 95% 98% HCO3 (Learning Objectives: 13-16, 19-22, 32, and 33) 148 mEq/L 3.8 mEq/L 9.5 mg/dl. 2.1 mg/dL 7.42 40 mm Hg 99% PH 7.32 28 26 1. Which patient needs to be assessed first based on the information above? Why? 2. What could be some possible causes of the hyperkalemia? 3. Patient B is also complaining of numbness and tingling, especially around the mouth. What are the other two electrolyte imbalances in this patient that could be causing these symptoms? 4. Discuss the possible etiology associated with each electrolyte imbalance identified in question number 3. 5. What manifestations are associated with the three electrolyte imbalances in Patient B?

Answer 1

1.According to the given information patient B should be assessed and manged first because the patient has a higher potassium levels(hyperkalemia).normal potassium levels is 3.5-4.5 meq/l.Low magnesium levels normal magnesium levels are 1.5-2.5 meq/l.hypocalcemia normal calcium levels are 8.5-10.5mg/dl.patient is in respiratory acidosis as evidenced by pH of 7.32 normal pH(7.35-7.45) and pco2 of 48 mmhg normal pco2 35-45 mmhg.So according to all these lab values the patient is in respiratory Vidois with severe electrolyte balance which can affect both the cardiac and respiratory dysfunction causing sudden cardio respiratory arrest and can at times be fatal .

2.possible causes of hyperkalemia

Hyperkalemia is caused when the potassium in the blood is not excreated out from the body and kidneys does this function of excreatimg potassium through urine.so if the kidney is not functioning properly it will not excrete it properly so diseases like acute kidney injury,chronic kidney disease.The excretion of potassium is mediated by a hormones called as aldosterone certain diseases reduce the production of these hormone which can again result in hyperkalemia.excessive consumption of potassium rich diet like melons bananas,potassium supplements can also lead to hyperkalemia.certain medications like antibiotics,anti hypertensives,blood thinners also cause hyperkalemia .some disease Condition like uncontrolled diabetes,rahbdomylosis,burns which cause reduced excretion of potassium and cause hyperkalemia.

3.jerky movements,twitching is caused in case of hypocalcemia as patient B has a very low calcium level of 7.5 and hypomagnesium with a magnesium level of 0.9.both these electrolytes help in the smooth functioning of Neuro muscular movement any alterations can cause irritability of neuromuscular system which can cause involuntary movements

4.Etiology of hypocalcemia are hypoparathyroidism.because of low secretion of parathyroid hormone it can cause low calcium levels.,taking a vitamin D and calcium deficient diet can cause hypocalcemia.Certain diseases like chronic kidney diseases,rahbdomylosis certain medication like calcium channel blockers excessive intake can cause reduced calcium levels.

Etilogy of hypomagnesemia.:Low magnesium level in the body is caused by low intake or malnourishment.Diarrhoea or GI malabsorption can also lead to low serum magnesium levels .certain chemotherapy medication like cisplatin can reduce magnesium in blood .certain medication like proton pumb inhibitor reduce the magnesium level.Increased urine output can lead to increase excretion of magnesium.

5.hyperkalemia and hypomagnesemia can cause arrythemia like ventricular tachycardia leading to poor perfusion and cardiac dysfunction.hypocalcemia can lead to tingling ,twitching and involuntary muscular movements..so the mouth twitching is because of hypocalcemia