Question

Group 1

You are the R.N caring for a 65-year-old woman admitted last evening with a recent history of cellulitis and a 3-day history of persistent vomiting and diarrhea. She takes no medications at home, other than a daily multivitamin. Her weight on admission was 153 pounds. The patient states her original weight is 165 pounds (75 kg). The nurse notes that the patient’s mucous membranes and skin are dry. Vital signs are temperature 99.8° F, pulse 112, respirations 32, and blood pressure 100/76. Her urine output over the last 8 hours is 125 mL. Labs reveal the following:

K+ 3.5 mEq/L	Hematocrit 53%	Urine specific gravity 1.033
Na+ 159 mEq/L	Hemoglobin 20 g/dL	Blood urea nitrogen (BUN) 28 mg/dL
Cl- 120 mEq/ L	Serum glucose 163 mg/ dl

ABG results

pH	7.30
PaCO2	2 mm Hg
HCO3	17 mE/L
PaO2	88 mm Hg

1. Analyze the assessment and laboratory findings and explain the patient’s fluid volume status. (USLO 1, 6)

2. This patient’s symptoms are most likely a result of which acid-base imbalance? Explain the rationale. (USLO 1)

3. The bicarbonate level of 17 mEq/L is the result of which factor? Which ABG finding indicates a worsening acid-base imbalance? (USLO 1)

4. What priority nursing and collaborative interventions do you anticipate for this patient? (USLO 1,6, 7)

5. Describe what interventions can be delegated to an unlicensed assistive personnel (UAP). Explain your rationale. (USLO 8)

Group 2

Answer 1

1.

It clearly indicates that the patient is dehydrated, which is caused by persistent vomiting and diarrhea.

This is evidenced by patient's mucous membranes and skin are dry, decreased urine output(Indicates Hypovolemia), hypotension(Due to decrease fluid volume), a slight increase in urine specific gravity(Concentrated urine), an increase in blood urea nitrogen, increase label of hematocrit and hemoglobin(Concentrated blood due to hypovolemia).

2.

The patient's symptoms are most likely the result of metabolic acidosis, it is mainly due to diarrhea and vomiting caused by regular use of multivitamin tablets(the iron content of multivitamin tablets can cause an adverse effect like nausea, vomiting, and diarrhea in regular use).

It the condition of acidosis because the blood pH is below 7.35 (that is 7.30), the acidosis is due to a low bicarbonate level that means it is due to metabolic cause.

The PaCO2 is 22 mm/Hg, that means it is in alkaline range because body tries to compensate the acidosis, resulting in hyperventilation (RR 33 breaths/min)

3.

The patient bicarbonate level is very low(17 mEq/L), it is a result of bicarbonate ion loss due to severe vomiting and diarrhea.

ABG shows the pH of blood is 7.30 which indicates worsen in acid-base imbalance.

4.

The priority nursing intervention includes

• Initiate intravenous fluid resuscitation
• encourage oral fluid intake
• provide potassium supplements
• administer antiemetics and antidiarrhoeal drugs
• monitor vital signs frequently
• measure the intake and output