case study 13

Case Study, Chapter 13, Fluid and Electrolytes: Balance and Disturbance
1. Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. 

What are possible causes of a low potassium level?
What action should the nurse take in relation to the serum potassium level?
What clinical manifestations might the nurse assess in Mrs. Dean?

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2. Conrad Jackson is a 28-year-old man who presents to the emergency department with severe fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he “ate something bad.” Upon admission his vital signs are a temperature of 102.7°F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas. 
The following results are returned from the laboratory:
Sodium (Na+)             150
Potassium (K+)           5.5
Chloride (Cl¯)             110
BUN                           42
Creatinine                    0.8
Glucose                       86
pH                               7.32
PaCO2                         35
HCO3¯                        20
PaO2                            90
O2 Sat                          98%

What is your interpretation of this arterial blood gas sample?
Explain the high potassium in this patient.
Calculate the patient’s anion gap:
What is the interpretation of this anion gap?


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