CS Ch10-TTE.docx - Case Study Chapter 10 Fluid and...

Case Study, Chapter 10, Fluid and Electrolytes: Balance and
Disturbance
1. Mrs. Dean is a 75-year-old woman admitted to the hospital for a small
bowel obstruction. Her medical history includes hypertension. Mrs. Dean is
NPO. She has a nasogastric (NG) tube to low continuous suction with a total
of 450 in the suction cannister. She has an IV of 0.9% NS at 83 mL/hr. Current
medications include furosemide, 20 mg daily IV and hydromorphone, 0.2 mg
every 4 hours IVP, as needed for pain. She has a foley draining about
250mL/every 8 hours. The morning electrolytes reveal serum potassium of
3.2 mEq/L. (Learning Objective 4)
a. What are possible causes of a low potassium level? Highlight
b. What action should the nurse take in relation to the serum potassium
level? What to assess?
c. What clinical manifestation in the patient might you see if the K+ level
continues to drop?
d. What is her I and O for a 24 hour period? Any concerns?
2. Conrad Jackson is a 28-year-old man who presents to the emergency
department with severe fatigue and dehydration secondary to a 4-day history
of vomiting. During the interview, he describes attending a family reunion
and states that perhaps he “ate something bad.” Upon admission his vital
signs are a temperature of 102.7°F, heart rate of 116 bpm, respiratory rate of
18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes
the patient has dry mucous membranes and tenting of skin. The physician
orders an IV to be started with 0.45% normal saline, and orders a serum
electrolyte and an arterial blood gas. (Learning Objective 7)
The following results are returned from the laboratory: Indicate which are a
concern -highlight
Lab Values
Sodium (Na+) 150
Potassium (K+)