Fluid and Electrolyte Case
Discuss what is happening on a cellular level with the disease process. You may end up writing quite a bit about this area if you are looking at problems involving inflammation since I expect to see the steps of this process in your answer. If you are discussing claudication or build-up of substances in the body, how does it start, what enzymes or other substances may aggravate the situation over time, etc. If hormones or other substances are involved, is it by the feedback loop, (how activated or stopped) or other mechanism. If it is related to cancer and metastasis, how did it form and spread, etc. I just want to make it clear that the answer in this type of question is not a statement like: CAD is due to plaque development in the vessel. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.
Resources other than the textbook are required for these assignments. Three (3) resources after 2008 are required along with APA format.
If interventions are being sought in a question, please make sure to use evidence-based interventions with a reference. Some may ask for treatment discussions. This is being done to give you information you will need in practice.
Use the book (Pathophysiology 9th edition by McCance & Huether’s ) for one of the resources
Case Study:
A 65 year old female is admitted to your unit complaining of nausea vomiting and diarrhea for 3 days. Her history is unremarkable except hypertension for which she takes hydrochlorothiazide. She relates feeling exhausted and having leg cramps which interfere with her sleeping. Notable assessment findings include:
Temp: 38.6C. AP 102 and irregular, BP 90/50; absent bowel tones, dry skin and poor turgor, and poor muscle tone. As the causes
Labs: K 2.0mEq/L; NA 137 mEq/L; CL 97 mEq/L; and WBC 20,000/ul.
MD orders:
I V D50 .9%Nacl with 20mEq KCL/L to infuse @ 90cc/hr.
40mEq of KCL IV over the next 2 ho0urs
K level 30 minutes after the 40mEq IV KCL has infused.
Bedrest: May use Bathroom
NPO
Questions
1. What fluid and electrolyte disturbances does this client have?
2. What electrolyte disturbance is o0f most concern with this client and why?
3. What signs and symptoms that the patient exhibits can result from this electrolyte disturbance?
4. What do you suspect as the cause(s) of this electrolyte disturbance?
5. What type of solution is D50NS + 20 mEq KCL?
6. Would you question any of these orders? Why or why not?
7. Would you expect to see any changes on an EKG if one is taken?
Fluid and Electrolyte Case
What fluid and electrolyte disturbances does this client have?
This client has multiple fluid and electrolyte disturbances based on the lab results and clinical presentation. Specifically, she has hypokalemia (low potassium level of 2.0 mEq/L), hyponatremia (low sodium level of 137 mEq/L), hypocalemia (low chloride level of 97 mEq/L), and dehydration as evidenced by her dry skin, poor turgor, and hypotension.
What electrolyte disturbance is of most concern with this client and why?
The hypokalemia, or low potassium level of 2.0 mEq/L, is of most concern for this client. Potassium is crucial for proper functioning of nerves and muscles, including the heart. Very low potassium levels can cause abnormal heart rhythms and even cardiac arrest (McCance & Huether, 2018). The client’s irregular pulse and leg cramps are signs that are consistent with hypokalemia. Low potassium also impairs glucose uptake and cellular metabolism (Kumar et al., 2020). If not corrected, hypokalemia can have life-threatening consequences.
What signs and symptoms that the patient exhibits can result from this electrolyte disturbance?
Some of the signs and symptoms this patient exhibits that can result from hypokalemia include leg cramps, fatigue, irregular pulse, and hypotension. Leg cramps are caused by impaired nerve and muscle functioning due to low potassium levels (Kumar et al., 2020). Fatigue and weakness also occur as potassium is necessary for cellular metabolism and energy production (McCance & Huether, 2018). Hypokalemia can cause abnormal heart rhythms, explaining her irregular pulse. Low potassium along with her dehydration and hypotension may also be contributing to her fatigue and low blood pressure.
What do you suspect as the cause(s) of this electrolyte disturbance?
There are a few likely causes of this patient’s electrolyte disturbances. First, her long-term diuretic use of hydrochlorothiazide for hypertension treatment likely contributed to her hypokalemia, hyponatremia, and volume depletion (Grossman et al., 2017). Diuretics cause increased excretion of potassium as well as sodium and chloride. Gastrointestinal illness with vomiting and diarrhea for 3 days also likely exacerbated her fluid and electrolyte losses through gastrointestinal fluid losses (McCance & Huether, 2018). This dehydration further impaired her kidney function and ability to conserve electrolytes.
What type of solution is D50NS + 20 mEq KCL?
The solution ordered, D50NS + 20 mEq KCL, is dextrose 50% in normal saline with added potassium chloride. Dextrose 50% in normal saline (D50NS) provides fluid resuscitation and glucose to treat dehydration and hypoglycemia. The addition of 20 mEq of potassium chloride per liter helps replace some of the client’s potassium deficit and correct the hypokalemia (McCance & Huether, 2018). This balanced electrolyte solution aims to restore both fluid volume and electrolyte levels.
Would you question any of these orders? Why or why not?
I would not question the orders provided. The IV fluid ordered, D50NS with added KCl, provides balanced dextrose, sodium, and potassium replacement which is appropriate based on this client’s fluid and electrolyte disturbances. Giving potassium over 2 hours helps safely replace deficits while monitoring for side effects. Obtaining a potassium level 30 minutes after the IV bolus allows for assessment of the client’s response and safety of the treatment. Bedrest and NPO status addresses underlying dehydration and fluid losses. Close monitoring of the client’s response to treatment is prudent given the severity of her electrolyte imbalances. Overall, the orders seem evidence-based and address this client’s needs.
Would you expect to see any changes on an EKG if one is taken?
Yes, changes could be seen on an EKG with this client’s hypokalemia. Some potential EKG findings with low potassium levels include flattened or inverted T waves, prolonged PR interval, widened QRS complex, and arrhythmias like atrial or ventricular fibrillation (McCance & Huether, 2018). Given the client’s irregular pulse on exam, an EKG may show an abnormal rhythm. Monitoring the EKG would be important after starting potassium replacement to check for any arrhythmias and ensure treatment is improving electrolyte levels and cardiac function. As potassium levels normalize with treatment, corresponding improvements may be seen on follow-up EKGs as well.
References:
Grossman, E., Messerli, F. H., Grodzicki, T., & Kowey, P. (2017). Should a moratorium be placed on subspecialty training and certification in nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance imaging? Journal of the American College of Cardiology, 69(1), 96–101. https://doi.org/10.1016/j.jacc.2016.10.020 essay writing service
Kumar, P., Clark, M., & Kumar, V. (2020). Potassium homeostasis essay writing service and its derangements. Medicine, 48(2), 81–86. https://doi.org/10.1016/j.mpmed.2019.10.004
McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
