A nurse is taking care of an 85-year-old woman in a hospital-based skilled nursi

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 eating well for the past 2 days. She has been lethargic, her skin is warm and dry, and she has had a decreased urine output. The following laboratory findings were returned from the laboratory immediately after morning report: Na 147 CI 110 K 4.0 Blood Gases pH 7.33 PCO_2 34 HCO_3 27 PO_2 96 Urine Urine Specific Gravity 1.040 Identify each of the abnormal laboratory findings in the above results. What specific electrolyte disturbance does the patient have? What clinical manifestations would the nurse expect to see with this electrolyte abnormality? If the patient had an increase in her potassium level, what clinical manifestations would the nurse monitor ? What abnormality of blood gas is seen in this patient? Make sure and provide a rationale for each result.

Explanation / Answer

Cl 110- Higher level (Hyperchloremia)

K 4.0- Normal

pH 7.33- Slightly acidic (academic condition)

PCO2 34- slightly lower- (alkalosis)

HCO3 27- slightly higher- (alkalosis)

PO2 96- normal

Urine specific gravity 1.040

2. The patient is having high level of chloride along with high level of sodium. Hyperchloremia is the condition in which chloride level become high. The symptoms involve high level of sodium (hypernatremia), kidney disorder, loss in appetite etc.The manifestations include dehydration, vomiting, high sugar level, edema, thirst, deep breath, hypertension and reduced cognitive function etc.

3. Increased potassium level is also called hyperkalemia. The clinical manifestations are: breathing problem, vomiting, irregular beats, pain in chest, weakness, numbness, fatigue etc.

4. High level of HCO3 which is the condition of metabolic alkalosis. Low level of PCO2 also indicated alkalosis.

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