Reference no: EM133529892
Case study: A 68 year old client presents to the emergency department with severe fatigue and a 4 day history of vomiting. The individual states he had very little to eat or drink during the last 4 days due to nausea. The client also reports he has not taken his prescribed medications due to the vomiting.
Admission vital signs: Temperature 102.7 F, heart rate 116, respiratory rate 20 breaths / minute, blood pressure 86/54
Admission assessment findings: Dry mucus membranes, tenting of the skin on the hands and arms, dark amber urine and the client reports having less urine than usual, nausea and vomiting, lethargy, muscle weakness.
Medical history: Hypertension, hyperlipidemia, history of heart failure, the client reports that a household family member had a confirmed case of influenza recently.
Laboratory values: Sodium 150, potassium 5.5, chloride 110, BUN 42, creatinine 0.8, pH 7.32, PaC02 35, HC03- 20, Pa02 90, 02 saturation (pulse ox) on room air 98%
Physician (HCP) orders: Insert IV and infuse 0.45% normal saline at 100 ml/hour, monitor vital signs every 2 hours and administer routine medications when it is appropriate. Medications: furosemide 40 mg by mouth daily in AM, metoprolol 25 mg by mouth 2 times a day.
Discussion Questions:
- What type of fluid balance problem is the client exhibiting?
- Discuss each of the electrolyte abnormalities present. What signs and symptoms would you expect for each one? How would each be treated? Provide rationale.
- What is a collaborative plan of care for this client? What was the rationale for the IV fluids ordered? What would be the most appropriate course of action related to the client's routine medications immediately following admission?
- What are the nursing considerations related to the client's medical history, history of present illness and the treatment plan?
- What is your interpretation of this arterial blood gas sample? Discuss anticipated signs and symptoms for the ABG interpretation.
- Explain the high potassium in this client.
- SBAR note: Write an SBAR note from the perspective of the nurse calling the provider (HCP) related to the scenario following the client's admission to the medical-surgical unit.