Question

T.J. is a 46-year-old science professor brought to urgent care this afternoon by his wife. T.J. has been at home for 3 days with severe diarrhea and vomiting. His youngest daughter was hospitalized earlier in the week with similar symptoms. T.J. has no significant medical history and takes no medications. Examination reveals an ill-appearing, pale, diaphoretic man who is having difficulty concentrating and answering questions. He has diffuse abdominal pain. Vital signs are as follows: Lying—HR 100, BP 100/80, resp 26, temp 100. Sitting—HR 136, BP 90/60. He has not urinated since yesterday morning.

1. What other laboratory or clinical data would be helpful in assessing T.J.’s fluid-electrolyte and acid-base status? (select all that apply)

a Further assessment could include inspection of mucous membranes for dryness, skin turgor, status of neck veins, and presence of dizziness with position change.

b A chemistry panel would be helpful in assessing for imbalances of serum sodium, potassium, and bicarbonate.

c Blood test to assess the level of glucose.

D Assessment of body temperature.

2. Which assessment data should be monitored during fluid replacement therapy to determine when adequate volume has been restored? (select all that apply)

A. Mental status should be assessed and expected to improve with adequate fluid replacement.

B. Vital signs should be monitored for resolution of tachycardia and postural symptoms, as well as intake and output.

C. Electrolytes should be monitored for resolution of any electrolyte imbalance.

D. Skin turgor and mucous membranes should be monitored for improvement of dehydration.

3. How might persistent vomiting and diarrhea alter acid-base balance? (select all that apply)

A. Metabolic acidosis may occur as a result of persistent diarrhea.

B. Vomiting may contribute to metabolic alkalosis.

C. Metabolic alkalosis may occur as a result of persistent diarrhea.

D. Vomiting may contribute to metabolic acidosis.

Answer 1

Hi Answer:

1. What other laboratory or clinical data would be helpful in assessing T.J.’s fluid-electrolyte and acid-base status? (select all that apply)

Answer: Option A & B

A. The further assessment could include inspection of mucous membranes for dryness, skin turgor, a status of neck veins, and presence of dizziness with the position change.

B. A chemistry panel would be helpful in assessing for imbalances of serum sodium, potassium, and bicarbonate.

Explanation: Whenever there is unbalance in the fluid-electrolyte and acid-base status it directly shows the effect on patient mucous membrane, skin and neck veins so by accessing these conditions a physician can make a preliminary decision regarding the major cause of illness. After that, the analysis of the sodium, potassium and bicarbonate concertation can be checked in the blood by the biochemical test.

2. Which assessment should data be monitored during fluid replacement therapy to determine when the adequate volume has been restored? (select all that apply)

Answer: Option A &D

A. Mental status should be assessed and expected to improve with adequate fluid replacement.

D. Skin turgor and mucous membranes should be monitored for improvement of dehydration.

Explanation: The fluid disturbance causes the direct effect on mental status as well as on the skin and mucous membrane so the improvement in the mental status and skin turgidity can be monitored during fluid replacement therapy.

3. How might persistent vomiting and diarrhea alter acid-base balance? (select all that apply)

Answer: Option A &B

A. Metabolic acidosis may occur as a result of persistent diarrhea.

B. Vomiting may contribute to metabolic alkalosis.