Case scenerio:L.L. is a 83-year-old woman whose son 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 two to three 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 (Lanoxin) 0.125 mg po daily.Captopril (Capoten) 25 mg po BID.Furosemide (Lasix) 40 mg po daily.Potassium chloride (K-tab) 20 mEq po daily.Simvastatin (Zocor) 20 mg po at bedtime.Subjective Data
Has been following a low sodium dietStates 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 swollenObjective Data
Temperature 98.2° F, pulse 88, respirations 20, BP 138/86Lungs clear to auscultation, breathing regular and unlabored+1 edema bilaterally in anklesMuscle strength in upper extremities normal and equal and in lower extremities weakSensation to all extremities normalAbdomen distended with hypoactive bowel soundsDiagnostic Studies
Lab valuesSodium 139.0 mEq/LPotassium 3.0 mEq/LHCO3- 25.4 mEq/LChloride 99.5 mEq/LDiscussion Questions: (10 points each) Address each question in full, complete sentences in your own words in the format of a paper. Provide the references as the last page.
1. Describe the composition of the body fluid compartments ?
2. Explain how fluid, electrolyte, and acid-base imbalances develops.
3. What are the potential etiologies for alterations in fluid, electrolyte, and acid-base balance?
4. Explain the differences that place the elderly compared with infants at greater risk for fluid balance alterations.
5. What is a possible pathophysiologic cause of her muscle weakness and dizziness?
6. What other symptoms presented may be related to this problem?
7. What additional signs and symptoms should the nurse assess L.L.. for?
8. What diagnostic test is indicated and why?
9. Which interdisciplinary team member should be involved in this case and provide a rationale?
10. What are the goals of care for patients who have alterations in fluid, electrolyte, and acid-base balance?
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