1. Identify at least five (5) assessment findings indicative of dehydration. 2. Identify at least two (2) of A.J.’s risk

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1. Identify at least five (5) assessment findings indicative of
dehydration.
2. Identify at least two (2) of A.J.’s risk factors for developing
acidosis. Consider renal function and
fluid volume status.
3. Interpret the ABG results and explain the rationale for the
findings. Identify HPI and Examination
findings to support the rationale for this ABG finding.
4. Define the potassium finding? Identify at least two (2) causes
of the potassium finding. Using the
signs and symptoms of A.J.’s physical examination, give at least
(3) manifestations of the
potassium finding.

1 Identify At Least Five 5 Assessment Findings Indicative Of Dehydration 2 Identify At Least Two 2 Of A J S Risk 1 (261.22 KiB) Viewed 39 times

Dehydration/Acidosis Case Study Overview Case studies are excellent ways to apply the skills that have been learned. In this case study, you will learn about the history, symptoms, and diagnosis of dehydration/acidosis. Directions Review the case study below and complete the questions. Case Study: Dehydration/Acidosis SUBJECTIVE: Patient's Chief Complaint: “I ate a hamburger for dinner yesterday, and my stomach has hurt ever since. I've had stomach pain, vomiting, and some diarrhea. I still have no appetite and I'm afraid to try and eat or drink anything. My stomach still hurts, even though I've vomited. I feel week and sweaty. I get dizzy when I stand up and start moving. I just don't have any energy." History of Present illness (HPI): Mrs. A.J. is an 89-year-old woman who was admitted to the hospital with clinical manifestations of acute gastroenteritis with possible renal failure. The patient's chief complaints are abdominal pain, nausea, vomiting, watery diarrhea for the past 24 hours, resulting in weakness, dizziness upon standing, and diaphoresis. She had been feeling well until eating a fast-food hamburger for dinner last night. She first suffered nausea and abdominal distention, which then progressed to vomiting and diarrhea. Vomiting did not relieve the abdominal distention. As symptoms worsened, she began to suffer chills and diaphoresis and recorded a temperature of 100.4 F. Her husband transported her to the Emergency Room overnight, and she was promptly admitted for acute gastroenteritis, dehydration, and renal insufficiency. Past Medical History (PMH): HTN x 30 years. Stable on medications. Post-Acute Myocardial infarction x 9 years Left Ventricular Congestive Heart Failure
Diabetes Mellitus 2 x 20 years, Stable. Osteoarthritis X 10 years Renal insufficiency in the past. Kidney function stable prior to admission Family History (Fam Hx) Father died of renal disease at age 73 Mother died of Acute Myocardial infarction at age 62 3 Siblings: Two sisters still alive. Brother died of cerebrovascular accident at age 74 Social History: Retired factory assembly worker Married 60 years to husband, who is alive and well Denies regular use of alcohol, tobacco, or illicit drugs Drinks 2-3 cups of coffee each morning Immunizations: Pneumonia Pneumovax shot at age 71. Influenza vaccination annually. Review of Systems (ROS): Positive for (+): Nausea, vomiting, retching, and abdominal pain, left upper quadrant pain, dry mouth, dizziness, diaphoresis, chills, tingling fingers, and toes, Negative for (+): Headache, stiff neck, visual changes, chest pain, shortness of breath, urinary frequency
Medications: Digoxin 0.125mg PO Daily Furosemide 40mg PO Daily Isbesartan 20mg PO daily Metformin 500mg PO BID Allergies: Penicillin (lip swelling and shortness of breath) OBJECTIVE: Physical Examination Specific abnormal exam findings in italics Vital Signs: BP: 85/52 HR: 114 RR: 30 T: 100.6F Ht: 4" 11" Wt: 107 lbs General: Pale, diaphoretic, elderly white female in mild distress. The patient's eyes appear sunken with dark circles. Neuro: Lethargic but awakens to voice.
Cranial Nerves II-XIl grossly intact Grip weak but equal Slightly decreased patellar and pedal deep tendon reflexes bilaterally Integumentary: Skin pale, warm to touch. Poor skin turgor. HEENT: PERRLA. No fundoscopic abnormalities EOMI Conjunctiva pale Non-erythematous TM's. Light reflexes intact Mucous membranes pale and dry Tongue rugged, dry Neck and Lymph Nodes: Neck supple, No JVD No carotid bruits on auscultation No cervical lymphadenopathy or thyromegaly Pulm: Lungs clear to auscultation bilaterally Heart: Sinus tachycardia with peaked T-waves and occasional PVC's on telemetry Normal S1, S2 without gallop, murmur, or rubs Faint Sz murmur heard on auscultation No peripheral edema Abdomen: BS hypoactive Diffuse abdominal tenderness, worse in LUQ. No rebound. Patient does have appendix No hepatosplenomegaly Genital / Rectum: Deferred Musculoskeletal: Full ROM with diffuse muscle weakness
Neuromuscular tone intact Grips equal 4/5 strength Extremities: Nails unremarkable for disease No peripheral edema or muscle wasting Laboratory and Test Results Lab Test 6 months ago Current Hemoglobin 12.4 g/dL 14.1 g/dL WBC (x103/mm) 5.6 21.3 Lymphs (%) 21.2 19.1 Neutrophils (%) 60.1 78.1 Na 136 151 K 4.1 5.4 Ca 8.9 9.0 BUN 18 47 Creatinine 0.9 2.3 Glucose 97 106 Hgb A1C 6.7 6.4
ABG pH 7.30 pCO2 27 HCO3 16 Radiology: Abdominal CT: Bowel air pattern indicative of distention. No signs of free air or obstruction. Appendix size appears normal. No hepatomegaly