Question

Patient Profile

E.G. is a 73-year-old woman whose daughter brings her to see the health care provider because she has had a case of the “stomach flu,” with vomiting and diarrhea for the past three to four days and is now experiencing occasional light-headedness and dizziness. Her past medical history includes hypertension, hypercholesterolemia, and mild heart failure. She is taking:

• Digoxin 0.125 mg po daily.
• Captopril 25 mg po BID.
• Furosemide 40 mg po daily.
• Potassium chloride 20 mEq po daily.
• Atorvastatin 20 mg po at bedtime.

Subjective Data

• Has been following a low sodium diet
• States her abdomen feels bloated and she has been constipated since the onset of the “flu”
• Has been taking her medications except for the potassium chloride pill because it upsets her stomach.
• Occasionally takes an extra “water pill” when her ankles are swollen

Objective Data

Physical Examination

• Temperature 98.2° F, pulse 88, respirations 20, BP 138/86
• Lungs clear to auscultation, breathing regular and unlabored
• +1 edema bilaterally in ankles
• Muscle strength in upper extremities normal and equal and in lower extremities weak
• Sensation to all extremities normal
• Abdomen distended with hypoactive bowel sounds

Diagnostic Studies

• Lab values
  • Sodium             139.0mEq/L
  • Potassium         3.0mEq/L
  • HCO₃^-               25.4mEq/L
  • Chloride           99.5 mEq/L

Discussion Questions

1. What is a possible pathophysiologic cause of E.G.’s muscle weakness and dizziness? What other symptom does E.G. have that may be related to this problem?
2. What factors contributed to the development of this electrolyte imbalance?
3. What should you be on an alert for in a patient who is on furosemide and digoxin and why?

4. What additional signs and symptoms should you assess E.G. for?
5. What diagnostic test is indicated and why?
6. Write three nursing diagnoses that are appropriate for E.G.
7. What inter-professional care would you anticipate for E.G.?
8. What instructions should you give E.G. regarding the signs and symptoms of this electrolyte imbalance and how to prevent it?

Answer 1

Answer 1: A possible pathophysiologic cause of E.G.’s muscle weakness and dizziness is gastroenteritis in the body.

The symptom does E.G. have that may be related to this problem is vomiting and diarrhoea.

Answer 2: The factors that contributed to the development of this electrolyte imbalance are insufficient intake of fluids, lack of rest, bacteria (due to contaminated food and water) and viruses.

Answer 3: The patient who is on furosemide and digoxin, an alert is the cause of ‘stomach flu’ symptoms. This is because, these drugs cause symptoms similar to ‘stomach flu’, like mild muscle cramps, mild to moderate abdominal pain and vomiting.

Answer 4: The additional signs and symptoms that should be assessed by me for the E.G are the heart beat rate and mental confusion.

Answer 5: The diagnostic test indicated is the level of different elements present in the body. This is important to know the homeostatic level of electrolytes in the body.

Answer 6: The three nursing diagnoses that are appropriate for E.G. are level of stomach pain, proper urination and excretion or not, and psychology studies.

Answer 7: The inter-professional care that would I anticipate for E.G. is proper consumption of water and minerals.

Answer 8: The instructions that I would give E.G. regarding the signs and symptoms of this electrolyte imbalance is to drink enough fluids. Electrolytes have important role in maintaining the homeostasis in the body. Electrolytes imbalance could be prevented sufficient water consumption in proper time.