Question

A nurse is taking care of an 85-year-old woman in a hospital based skilled nursing facility. In report, the nurse is told the patient has not been breathing well for the past 2 days. She has been lethargic, her skin is warm and dry, and she has a decreased urine output. The following laboratory findings were returned from the laboratory immediately after morning report:

Na: 147

Cl 110

K 4.0

Blood Gases:

pH 7.33

PCO2 34

HCO3 27

Po2 96

Urine:

Urine Specific Gravity 1.040

Address the following:

1. Identify each of the abnormal laboratory findings in the above results.
2. What specific electrolyte disturbance does the patient have?
3. What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?
4. If the patient had an increase in her potassium level, what clinical manifestations would the nurse monitor for?
5. What blood gas abnormality is seen in this patient? Please discuss the rationale for your answer.
6. What are the three major mechanisms of pH regulation?

Answer 1

1. The abnormal findings in the laboratory investigations are

Sodium = 147 mEq/l

Blood gases :-

- pH= 7.33

- pCO2 = 34 mmHg

- urine :-

Urine specific gravity = 1040

2. The specific electrolyte disturbance the patient have is decreased sodium levels - hyponatremia .

3. The clinical manifestations of hyponatremia are :-

- nausea

- vomiting

- water intoxication

- dizziness

- edema

- headache

- confusion

- altered mental status

- sleepiness

- decreased reflexes

4. If the patient have an increased in potassium level ,the nurse should monitor for the sign and symptoms :-

- ECG changes :-

Tall peaked T waves

Prolonged PR waves

Flat P waves

Widened QRS complex

- decreased reflexes

- arthymias

- muscle relaxation