MedSurg Group2

Group 2
Bascon, Uriel
Cose, Mhendylean
Daño, Marielle Deguilmo,
Rhency Econar,
Quennie April
Esmalin, Jomil
Heyrosa, Rusty Vincent
Javelona, Jyssa Mae
Lacangan, Thea Yvonne
Lamosao, Shean
Task 2. Two scenarios will be given to assess your ability to apply the concepts you have
learned. From the scenario given, identify the disorder and answer the questions provided.
Also, formulate two individualized nursing care plans using the institutional format.
Scenario #1. A 36-year-old client was admitted with gastroenteritis. He has been vomiting and
having severe diarrhea for 2 days. He is very weak. The current laboratory results are Na+ 128
mEq/L, K+ 2.8 mEq/L, Cl− 90 mEq/L. The physician orders IV of 0.9% normal saline solution at
100 mL/hr, NPO, and strict I & O in absolute figures.
1. What fluid imbalance is the client experiencing?
• The patient is experiencing dehydration as evident by vomiting and severe diarrhea for 2days.
2. What electrolyte imbalance is the client experiencing?
• As indicated the laboratory the patient’s Na+, K+ and Cl are low. Therefore the patient is
experiencing hyponatremia, hypokalemia and hypochloremia
3. From the scenario, what other clinical manifestations can you observed in clients with this
disorder?
Hyponatremia • Metabolic Alkalosis
• seizures and coma Hypochloremia
• tetany • weakness or fatigue
Hypokalemia • diarrhea or vomiting
• Cardiac Dysrythmias
4. Create two individualized nursing care plans from the scenario.
5.Give two medical management that a doctor may prescribe for this scenario and explain why.
• Strictly monitor intake and output. To make sure that the patient has enough electrolyte and
nutrients in the body.
• Administer IV of 0.9% normal saline solution. To compensate the loss electrolytes to avoid
dehydration
Scenario #2. P.B., a 74-year-old woman who lives alone, is admitted to the hospital because of
weakness and confusion. She has a history of chronic heart failure and chronic diuretic use
Objective Data
Physical Examination
• Neurologic: Confusion, slow to respond to questioning, generalized weakness
• Cardiovascular: BP 90/62, HR 112 bpm and irregular, 3; ECG indicates sinus tachycardia
• Pulmonary: RR 12 and shallow
• Additional findings: Decreased skin turgor, dry mucous membranes
Laboratory Results
• Serum electrolytes
• Na+: 141 mEq/L (141 mmol/L)
• K+: 2.5 mEq/L (2.5 mmol/L)
• Cl−: 85 mEq/L (85 mmol/L)
• HCO3−: 34 mEq/L (34 mmol/L)
• BUN: 42 mg/dL (15 mmol/L)
• Hct: 49% Arterial blood gases

o pH: 7.52
o PaCO2: 55 mm Hg
o PaO2: 88 mm Hg
o HCO3−: 34 mEq/L (34 mmol/L)
1. Evaluate P.B.’s fluid volume and electrolyte status. Which physical assessment findings
support your analysis?
• The patient is dehydrated or experiencing fluid volume deficit as evident by decreased skin
turgor, dry mucous membrane, low blood pressure, ECG indicates sinus tachycardia and
generalized weakness.
• Electrolyte status: The patient shows symptoms of hypokalemia and hypochloremia as evident
by K+: 2.5 mEq/L and Cl−: 85 mEq/L (85 mmol/L) in serum electrolytes test.
• Elevated BUN and HCO3
2. Which laboratory results support your analysis? What is the most likely etiology of these
imbalances?
• Serum electrolyte levels are not normal; there are some that are elevated and there are some
that are low. There are several reasons for these imbalances. The first is old age, which makes
the kidney weak, and the second is that the patient is taking diuretics, which causes the patient
to urinate more frequently to get rid of sodium and water in the body, and as a result of
eliminating the salt in the body, it causes the chloride to go low since the main source of
chloride is salt. There are also diuretics that cause the body to eliminate more in the urine.
3. Analyze the arterial blood gas results. What is the etiology of the primary imbalance? Is the
body compensating for this imbalance?
• Metabolic Alkalosis, Partially Compensated
• pH level, PaCO2 and HCO3 are all not normal
• An imbalance in the synthesis of acids or bases and their excretion by the kidneys results in
metabolic alkalosis or acidosis. In this patient’s case the chronic diuretics is the etiology of the
imbalance.
• In a case of acid-base imbalance metabolic systems compensate for respiratory disruptions, the
respiratory system compensates for metabolic irregularities. The compensatory processes may
first bring the pH near to normal.
3. Discuss the role of aldosterone in the regulation of fluid and electrolyte balance. How will
changes in aldosterone affect P.B.’s fluid and electrolyte imbalances?
• Aldosterone has an impact on the body by binding to and activating a receptor in the cytoplasm
of renal tubular cells. The renal tubular cells then become stimulated by the activated receptor
to create ion channels. It encourages sodium reabsorption into the circulation as well as
potassium excretion through the urine as a result. Changes in the patient's aldosterone, for
example, aldosterone will increase, It will cause an increase in Na+ and water because
aldosterone encourages the retention of sodium and water, but a drop in potassium level.
Chloride level will also increase as a result of increase in Na+ since the source of chloride is
salt or sodium.
4. Develop two care plans for P.B. while she is in the hospital.
To address hypokalemia
1. Make a daily food and fluid and weight chart.To keep track of the patient's electrolyte gain
and loss and monitor their condition
2. Help the patient choose healthy food options after a high potassium diet.To ensure that the
patient's body is receiving enough nutrients and electrolytes.
To address hypochloremia
1. Monitor intake and output. To keep tract of the patient’s condition

2. Encourage diet that is rich in chloride. To compensate with the loss of chloride

MedSurg Group2

Uploaded by

Copyright:

Available Formats

MedSurg Group2

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

MedSurg Group2

Uploaded by

Copyright:

Available Formats

Group 2

1. What fluid imbalance is the client experiencing?

2. What electrolyte imbalance is the client experiencing?

• seizures and coma Hypochloremia

• tetany • weakness or fatigue

Hypokalemia • diarrhea or vomiting

• Neurologic: Confusion, slow to respond to questioning, generalized weakness

• Pulmonary: RR 12 and shallow

• Additional findings: Decreased skin turgor, dry mucous membranes

• Na+: 141 mEq/L (141 mmol/L)

• K+: 2.5 mEq/L (2.5 mmol/L)

• Cl−: 85 mEq/L (85 mmol/L)

• HCO3−: 34 mEq/L (34 mmol/L)

• BUN: 42 mg/dL (15 mmol/L)

• Hct: 49% Arterial blood gases

• Elevated BUN and HCO3

• Metabolic Alkalosis, Partially Compensated

• pH level, PaCO2 and HCO3 are all not normal

1. Monitor intake and output. To keep tract of the patient’s condition

You might also like