FLUID AND ELECTROLYTE: BALANCE AND DISTURBANCE

FLUID AND ELECTROLYTE: BALANCE AND DISTURBANCE

1. Mrs. Dean is a 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. (Learning Objective 4) 
2. What are possible causes of a low potassium level? 

The possible cause of decrease in potassium is furosemide which is among Mrs. Dean’s treatment for hypertension. The furosemide causes  a reduction in the potassium level in her body due to the  electrolyte  imbalance it causes when it is administered.

• What action should the nurse take in relation to the serum potassium level? 

The nurse should first report her findings to the doctor incharge as required then. Then the nurse will administer Mrs. Dean with IV potassium diluted in IV fluids as directed by the doctor

• What clinical manifestations might the nurse assess in Mrs. Dean?

The following clinical manifestations was assessed in the patient

• Fatigue (General weakness)
• Tingling sensation and body numbness
• Difficulty in breathing
• Nausea, vomiting and abdominal cramping due digestive problems.
• Mood swings
•  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 electrolyte and an arterial blood gas. (Learning Objective 7) 

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%

1. What is your interpretation of this arterial blood gas sample? 

The patient’s arterial blood gas sample reveals

1. Hyperkalemia

This is when the potassium level in the body is beyond the normal range.

Conrad Jackson’s blood gas sample has potassium level of 5.5 mEq/L which is higher than the expected level range  of 3.5-5 mEq/L.

• Hypernstremia

This is when there level of sodium has risen above the normal range.

The patient, Jackson, blood gas sample reveals a sodium level of 150mEq/L which is higher than the normal range of 135 -145mEq/L.

• Explain the high potassium in this patient. 

The main cause of high potassium level in Conrad Jackson’s blood in dehydration. Dehydration comes due to the continuous vomiting of the patient and as a result the electrolytes concentration in the blood in increase especially potassium.

• Calculate the patient’s anion gap

Na =  150 mEq/L

Cl = 110 mEq/L

HCO₃ = 20 mEq/L

Therefore, AG = 150 – ( 110 + 20 )

= 20 mEq/L

• What is the interpretation of this anion gap?

The anion gap shows poisoning or intoxication. This because the anion gap is  20 mEq/L  which is higher than the normal range of 3 to 11 mEq/L.