Medical-Surgical Nursing:Assessment and Managementof Clinical Problems 9th Edition by Sharon Lewis,Shannon Ruff Dirksen,Margaret McLean Heitkemper,Linda Bucher

Exercise 35

CASE STUDY Fluid and Electrolyte Imbalance Patient Profile P.B., a 74-year-old woman who lives alone, is admitted to the hospital because of weakness and confusion. She has a history of chronic heart failure and chronic diuretic use. Objective Data Physical Examination
• Neurologic: Confusion, slow to respond to questioning, generalized weakness
• Cardiovascular: BP 90/62, HR 112 bpm and irregular, peripheral pulses weak; ECG indicates sinus tachycardia
• Pulmonary: RR 12 and shallow
• Additional findings: Decreased skin turgor, dry mucous membranes Laboratory Results
• Serum electrolytes ■■■ Na⁺: 141 mEq/L (141 mmol/L) ■■■ K⁺: 2.5 mEq/L (2.5 mmol/L) ■■■ Cl⁻: 85 mEq/L (85 mmol/L) ■■■ HCO₃⁻: 34 mEq/L (34 mmol/L)
• BUN: 42 mg/dL (15 mmol/L)
• Hct: 49%
• Arterial blood gases ■■■ pH: 7.52 ■■■ PaCO₂: 55 mm Hg ■■■ PaO₂: 88 mm Hg ■■■■ HCO₃⁻: 34 mEq/L (34 mmol/L)
-Evaluate P.B.'s fluid volume and electrolyte status.Which physical assessment findings support your analysis? Which laboratory results support your analysis? What is the most likely etiology of these imbalances?