Case Study: Fluid and Electrolyte Imbalances- Chapter 39

Mr. Abdul is a 76-year-old male who has been admitted to the hospital with a diagnosis of congestive heart failure (CHF). He complains of being tired all the time and barely having enough energy to sit up sometimes. “I think I’ve put on some weight. My waistband and shoes seem to be tighter and more uncomfortable to wear.” He has a history of coronary artery disease. He has smoked one pack of cigarettes per day for 56 years. He has no known drug allergies (NKDA) and has full code status.Mr. Abdul’s vital signs on admission are T 36.5° C (97.7° F), P 118 regular and bounding, R 32 and labored, BP 160/100, with a pulse oximetry reading of 90% on room air. He denies pain and is alert and oriented to person, place, time, and event. He can move all extremities easily but requires assistance with activities of daily living (ADLs) such as bathing and dressing, He becomes short of breath on exertion. He has fine crackles throughout all lung fields and has a moist, nonproductive cough. Bowel sounds are active in all four quadrants. The last bowel movement, a formed brown stool, was yesterday. His skin is warm, dry, and slightly pale. He has +3 pitting edema in both ankles and +1 bilateral dorsalis pedis and posterior tibial pulses. Admission laboratory test results are as follows:• Electrolytes: sodium 142 mEq/L; potassium 3.3 mEq/L; chloride 100 mEq/L; bicarbonate 29 mEq/L; blood urea nitrogen 18 mg/dL; creatinine 0.8 mg/dL; glucose 140 mg/dLComplete blood count: hemoglobin 15 g/dL; hematocrit 45%; white blood cells 8000 mm3; platelets 300,000 mm3• Arterial blood gases: pH 7.34; PCO2 56 mm Hg; bicarbonate 32 mEq/L; PO2 80 mm Hg; O2 saturation 90%.Medications are as follows:• Digoxin 0.125 mg PO q A.M.• Furosemide 80 mg IV now, then Lasix 40 mg PO q A.M. beginning tomorrowTreatment orders are as• O2 2 L/min per nasal cannula• Vital signs q 4 hr. with pulse oximetry• Daily weight• Strict intake and output• Diet: no added salt• Activity: bed rest• Saline lock

5. On day 2 of his hospital stay, Mr. Abdul begins to complain of increased muscle weakness and cramping. Assessment findings include an irregular apical pulse and hypoactive bowel sounds. Provide a possible explanation for these findings and identify appropriate nursing action.
6. Mr. Abdul is at risk for acid base imbalance.a. What are the four Acid-Base imbalances?b. Describe the underlying causes for eachc. Describe the clinical manifestations (i.e. signs and symptoms)d. What are interventions for each acid-base imbalancee. What is the result of Mr. Abdul arterial blood gases.f. What acid-base imbalance is Mr. Abdul experiencing? Give a rationale for your answer.

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