Question

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

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

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?

What factors contributed to the development of this electrolyte imbalance?

What should you be on an alert for in a patient who is on furosemide and digoxin and why?

What additional signs and symptoms should you assess E.G. for?

What diagnostic test is indicated and why?

Write three nursing diagnoses that are appropriate for E.G.

What interprofessional care would you anticipate for E.G.?

What instructions should you give E.G. regarding the signs and symptoms of this electrolyte imbalance and how to preven it?

Answer 1

<•>The possible pathophysiological cause of muscle weakness and dizziness in the patient is because of hypokalemia .A very low levels of potassium in the blood can alter the electrolyte balance.This alters the cellular mechanisms and causing muscle weakness gradually imbalance if central nervous system causes dizziness.

<•>The others symptoms which EG has in relation to the problems are

• Gastrointestinal disturbances like nausea , vomiting, bloating , constipation,hypoactive bowel sounds
• CNS issues like light headedness

<•>The factors contributed to the development of electrolyte imbalance are

• Diarrhoea
• Vomiting
• Non medication adherence:not taking potassium supplements
• Medication : Diuretics

<•>The patient who is on furosemide and digixin should be monitored carefully for the following

• Levels of magnesium, digoxin and potassium has to be monitored because these levels can be altered
• The heartbeat,rate, rhythm has to be monitored before administration of digoxin
• Intake and output had to be monitored before and after administration of furosemide
• Muscle cramp, weakneas ,changes in heart rate has to be monitored and alerted for preventing complications

<•>The additional signs and symptoms to be assessed are

• Assess for cardiac functions by monitoring the blood pressure heart rate and rhythm
• Signs of fluid deficiency because of diarrhoea and vomiting
• Mental status examinaction for altered consciousness related to electrolyte imbalance
• Polyuria
• Polydypsia

<•>The diagnostic tests which can be indicated are

• ECG to assess the cardiovascular changes
• Urine test to assess the presence of any electrolytes

<•>The nursing diagnosis appropriate to the condition are

• Imbalanced fluid volume/Deficient fluid volume related to diarrhoea as evidenced by observation
• Hypokalemia related to diuretics as evidenced by decreased potassium levels, lack of potassium supplement intake, muscle weakness
• Imbalanced bowel movement realted to constipation as evidenced hypoactive bowel sounds

<•> The interprofessional teams which will be included are medical intensivist, gastroenterologist and nursing team

<•>The instructions which has to be given are

• Signs and symptoms like muscle cramp, weakness, palpitations indicates low potassium levels and it is a must to ensure potassium supplement is taken
• Watch for urine output because excess urine output because of diuretics can lead to excretion of potassium.To prevent this potassium supplement to be taken