Follow the directions related to the patients presented below.
Please write in paragraphs using 12 font, not in first person, and provide headings
throughout the paper. Utilize the APA guidelines in online portion of the course.
F&E case study:
A 68 year-old alcoholic is admitted with medical diagnoses of cirrhosis of the liver, atrial
fibrillation, and hypertension. At home he has been on a low Na+ diet and he takes digoxin
0.125 mg daily.
1. Initial assessment: (explain each, including appropriate pathophysiology; may list this
section only in bullet format and then explain adequately in paragraphs)
– obvious ascites with 3+ peripheral edema
– VS: 108/66 lying, 82/48 standing; 116 and regular but weak; 32 and shallow
– breath sounds clear but diminished all lobes
– hypoactive bowel sounds x 4
– urine voided shortly after admission: 80 mL, very concentrated, specific gravity 1.048
– he demonstrates alternating drowsiness and confusion and is c/o cramping in the lower
extremities
– at one point during the assessment, he looks at you and comments “Oh, my dear, you
look just like an angel.”
– Admitting labs: H&H, Na+, and BUN all elevated; K+ 2.7; total protein 5.0, albumin
2.8; digoxin level 0.6 ng/mL.
2. This patient has experienced a fluid shift. Explain: fluid compartment(s) involved??
Direction of fluid movement?? Cause of such in his case??
Include appropriate pathophysiology.
3. Describe actual vs relative hypovolemia.
4. MDs orders: (explain each, including the goal of each therapy)
– 1000 ml D5NS with 30 mEq KCl at 125 ml/hr
– Albumin 25% 100 mL now (1 bottle) and again at 0600 the next morning
– Furosemide 80 mg IVP
Describe appropriate assessments by the nurse during each therapy above.
5. He continues to receive D5NS with KCl during the evening and night shifts and
demonstrates marked improvement. However, the night nurse reports that the ordered 0600
albumin infused “ahead of schedule” and your initial assessment reveals:
BP 180/110, pulse 120 and bounding
Extreme dyspnea with crackles throughout both lung fields to mid-scapular area
Engorged neck veins at 90 degrees
What has occurred and why?? What would you as the RN do immediately and what
MDs orders would you anticipate?? Explain rationale for each.
Acid-Base Case Study:
An 83 year-old male is admitted after 3 days of vomiting and ingesting large amounts of baking
soda for his “sour stomach”. Shortly after admission he demonstrates irritability that progresses
to physical belligerence and within an hour, he experiences a generalized motor seizure.
VS: 178/110, 104 and regular, 7 and shallow with periods of 10-second apnea 3 times per
minute.
ABGs: pH: 7.48; PaCO2: 55 mmHg; HCO3: 34 mEq/L; PaO2: 60 mmHg; SaO2: 82%
Serum K+: 2.4 mEq/L
1. Provide a complete interpretation of the above AGB report and explain the etiology of
the imbalance and oxygen status. In other words, what lead to the above abnormal data,
including vital signs, altered K+, and the seizure? Explain each piece of data with
appropriate rationale.
2. Why is this imbalance so dangerous for an 83 year-old patient? Provide adequate
explanation.
