Question

K.B. is a 32-year-old woman being admitted to the medical floor for complaints of fatigue and dehydration.

While taking her history, you discover that she has diabetes mellitus (DM) and has been insulin-dependent

since the age of 8. She has undergone hemodialysis (HD) for the past 3 years. Your initial assessment of

K.B. reveals a pale, thin, slightly drowsy woman. Her skin is warm and dry to the touch with poor skin tur-

gor, and her mucous membranes are dry. Her vital signs (VS) are 140/88, 116, 18, 99.9° F (37.7° C). She tells

you she has been nauseated for 2 days so she has not been eating or drinking. She reports severe diar-

rhea. Serum calcium, phosphate, magnesium, and a complete blood count (CBC) have been drawn but the

results are not yet available. The following blood chemistry results are back:

1. What aspects of your assessment support her admitting diagnosis of dehydration?

2. Explain any lab results that might be of concern.

Laboratory Test Results

Sodium 145 mEq/L

Potassium 6.0 mEq/L

Chloride 93 mEq/L

Bicarbonate 27 mEq/L

BUN 48 mg/dL

Creatinine 5.0 mg/dL

Glucose 238 mg/dL

Answer 1

1. Assessment:

• History of the patient that helps to support of dehydration as she was not drinking enough water that is sufficient to her body for the last two day and she was having diarrhea.
• Patient skin was dry and warm
• Patient has a poor turgor skin as well as dry mucous membrane which is sign for dehydration
• Hypertension and increased pulse rate are the vital and evidence for inadequate fluid intake.
• Imbalanced nutrition and unable to digest nutrients because of nausea also evidence for dehydration.
• Physical examination of pallor and fatigue and hyperkalemia is the signs for dehydration.

2.Potassium (6.0mEq/L) hyperkalemia is cause by dehydration( sweating,vomiting) results in loss of electrolytes and more water is lost from the blood that will increase sodium concentration in the blood.

Blood Urea Nitrogen (48mg/dl) these test will be performed to determine the function of kidneys.If kidney are not function properly blood urea nitrogen level will be increased in the body. Increased Blood urea nitrogen is indication for heart failure,dehydration.Decreased level of blood urea nitrogen is sign for liver disease.

Creatinine 5 mg/dl increased creatinine level in the blood that shown that kidneys are not working properly and dehydration.If patient have dehydration have a low blood volume and take dietary supplements.

Glucose 238mg/dl Decreased fluid intake can lead hyperglycemia. High blood glucose level can increase the frequency of urination that results dehydration.