Fluid and Electrolyte Case
Discuss what is happening on a cellular level with the disease process. You may end up writing quite a bit about this area if you are looking at problems involving inflammation since I expect to see the steps of this process in your answer. If you are discussing claudication or build-up of substances in the body, how does it start, what enzymes or other substances may aggravate the situation over time, etc. If hormones or other substances are involved, is it by the feedback loop, (how activated or stopped) or other mechanism. If it is related to cancer and metastasis, how did it form and spread, etc. I just want to make it clear that the answer in this type of question is not a statement like: CAD is due to plaque development in the vessel. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.
Resources other than the textbook are required for these assignments. Three (3) resources after 2008 are required along with APA format.
If interventions are being sought in a question, please make sure to use evidence-based interventions with a reference. Some may ask for treatment discussions. This is being done to give you information you will need in practice.
Use the book (Pathophysiology 9th edition by McCance & Huether’s ) for one of the resources
Case Study:
A 65 year old female is admitted to your unit complaining of nausea vomiting and diarrhea for 3 days. Her history is unremarkable except hypertension for which she takes hydrochlorothiazide. She relates feeling exhausted and having leg cramps which interfere with her sleeping. Notable assessment findings include:
Temp: 38.6C. AP 102 and irregular, BP 90/50; absent bowel tones, dry skin and poor turgor, and poor muscle tone. As the causes
Labs: K 2.0mEq/L; NA 137 mEq/L; CL 97 mEq/L; and WBC 20,000/ul.
MD orders:
I V D50 .9%Nacl with 20mEq KCL/L to infuse @ 90cc/hr.
40mEq of KCL IV over the next 2 ho0urs
K level 30 minutes after the 40mEq IV KCL has infused.
Bedrest: May use Bathroom
NPO
Questions
1. What fluid and electrolyte disturbances does this client have?
2. What electrolyte disturbance is o0f most concern with this client and why?
3. What signs and symptoms that the patient exhibits can result from this electrolyte disturbance?
4. What do you suspect as the cause(s) of this electrolyte disturbance?
5. What type of solution is D50NS + 20 mEq KCL?
6. Would you question any of these orders? Why or why not?
7. Would you expect to see any changes on an EKG if one is taken?