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

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

Answer 1

Ans 1. Nursing diagnosis are apptopriate for E G :

- electrolyte imbalance related to vomiting and nausea as manifested by dehydration.

- acute abdominal pain related to gastritis as manifested by verbalization.

- alterations in cardiac output related to mild heart disease as evidenced by hypertension and observations.

Ans 2. Diagnostic test:

1. prick skin testing to introduce a small puncture to identify the IgE antibody against the infection.

2. Blood test: serum specific immune assay theat to find out the any allergic substance.

3. Food patch test: this is another type of allergy test to identify the tolerance and does not cause the Eoe ( Eosinophilic esophagitis).

Ans 3. Inter professional care: Food test directed elimination diets- if you are noted to have specific food sensitivities after prick skin testing your doctor.

Empiric elimination diet: some substance that are allergic to person, to eliminate from the diet.

Elemental diet: should follow strict dietary pattern, all allergen are removed from the diet.

Medical therapy: endoscopy, other treatments should help to treat the particular disease.

Ans 4. The main things are - to avoid particular allergies that causing the affect e.g Try to reduce the causing agent of hypertension and other mild heart disease.

Give standard therapies to eliminate the symptoms to some extent.

Alternative therapy is used to cover the symptoms of the e.g Improve the gastrointestinal tract infection.

Give electrolyte solution like ns, crystalloid system.