Reference no: EM133460972

Assignment:

Donald R., age 75 years, was admitted to the hospital with severe dyspnea. He has a history of chronic alcohol abuse and cirrhosis. On admission, the nurse assesses the following: thin, chronically ill-appearing. Blood pressure 108/62 mmHg, pulse 118/min, RR 26/min, temperature 36.6°C (97.8°F). He has 3+ pitting generalized edema. His abdomen is distended and tight. He has orthopnea and complains of shortness of breath. Mr. R states that he has been confined to his chair or couch for the past 2 weeks because of his breathing difficulty and general weakness.

1. Identify factors in Mr. R's history that affect his fluid and electrolyte balance. What additional data would be important to elicit?

2. Given Mr. R's vital signs, what changes would support the presence of orthostatic hypotension?

3. Mr. R has generalized edema. Compare and contrast the pathophysiologic causes of generalized versus localized edema.

Clinical update: Mr. R's serum laboratory results are Na 128 mEq/L, Ca++ 5.8 mg/dL, K+ 5.2 mEq/L, osmolality 315 mOsm/L, BUN 40 mg/dL, and Cr 4 mg/dL.

4. Examine Mr. R's BUN and creatinine and calculate his BUN to Cr ratio. What is your interpretation of these results?

Wagner et al., Instructor's Resource Manual for High-Acuity Nursing, 7th Edition