Question

Several patients were admitted in the medical ward. Answer the following questions pertinent to the patients’ conditions.

PATIENT A–Presented in the emergency department with severe headache, irritability, and tremors after finishing a full marathon. Laboratory values reveal Serum sodium level of 130 mEq/L.

PATIENT B–Presented in the emergency department with severe body malaise, diminished bowel sounds, and ECG reveals an extra U-wave in the tracing after 8 bouts of watery diarrhea. Laboratory values further reveal a Serum potassium level of 3.0 mEq/L.

PATIENT C–A post thyroidectomy patient presented with severe muscle cramps and prolongation of QT-interval in the ECG and was referred to the medical consultant for co-management. Serum calcium level is 4.0 mEq/L.

PATIENT D–A patient receiving magnesium for the management of seizure disorder suddenly presented with depressed deep tendon reflex and becomes stuporous. Laboratory values reveal a Serum Magnesium level of 2.6 mg/dL.

1. Given the Patient B’s presentation, trace the pathophysiological cause of the decrease in serum potassium level.
2. What will be the emergency medication that should be readily available in managing the disorder apparent for Patient D?
3. Explain the relationship of thyroid surgery and the development of hypocalcemia in Patient C.
4. Explain the relationship of Patient A’s prior activity and the development of hyponatremia.
5. Explain the mechanism behind the development of prolonged QT –interval for Patient C.
6. Enumerate at least one (1) nursing diagnosis for Patient A, B, C, and D.

Answer 1

1 ) the condition of patient B is an example of hypokalemia ( below 3.5 mEq/L) due to diarrhoea . the main causes of hypokalemia includes inadequate dietry potassium intake , use some of medication ( thiazides and loop diuretics , cortico steroids , pencillin , amphotericin B ) , GI loss of potassium ( vomiting and gastric suction , diarrhoea , recent iieostomy , villous adenoma) , severe alcoholism ,anorexia nervosa , persistant insulin hypersecretion.

large amount of potassium are contained in intestinal fluid, there for frequent diarrhoea leads to potassium deficit .

2 ) the condition of patient D , is hypermagnesemia ( serum mg level above 2.3 mg / dl .) due to exessive magnessium asministration. the emergency medication used in this case is iv calcium gluconate

3 ) the scenario of patient C is an example of hypocalcemia associated with thyroidectomy. it is a surgical complication can occure as result of damage to the parathyroid gland near to the thyroid , that cause decreased secreation of parathyroid hormone leads  to decresed blood calcium level and increased blood phosphorus .

4 ) in case of patient A hyponatremia can occured as a result of prolonged physical activity that cause large sodium loss in sweat. excessive drinking of too much water also cause hyponatremia in athlets due to rapid fluid absorption of fluid along with impaired free water excretion.

5) proloned QT interval in ecg  is a significant sign of hypocalcemia.it is due to prolongation of ST segment ,and may leads to torsades de points, a type of VT may occure .  

6) patient A - risk for electolyte imbalance ( hyponatremia)

patient B - risk for electolyte imbalance ( hypokalemia )

patient C -risk for electrolyte imbalance ( hypocalcemia)

patient D - risk for electrolyte imbalance ( hyper magnesemia)