An 87-year female, with a 3-day history of intermittent abdominal pain, abdomina

Question

An 87-year female, with a 3-day history of intermittent abdominal pain, abdominal bloating, and nausea and vomiting, came to the emergency department. She moved from Puerto Rico to join her grandson and his family only 2 months ago and speaks very little English. All information was obtained through her grandson. PMH includes an abdominal hysterectomy 12 years ago and an inguinal hernia repair 2-years ago. She has no history of coronary artery disease, diabetes or pulmonary disease. She takes only ibuprofen occasionally for mild arthritis. She has no known drug allergies (NKDA). Vital signs are: Blood Pressure 134/84, Pulse 84 beats/minute and regular, Respirations 20/minute and Temperature 97.2º F (36.2 ºC). An IV of D5 ½ NS with 20 mEq KCl at 100 mL/hour is started Nasal O2 at 2 L is also ordered. After 3-days of NGT suctioning the client’s symptoms are unrelieved. She reports continued nausea, cramping, and sometimes very strong abdominal pain. She seems increasingly lethargic. You look up her latest laboratory test values and compare them to the admission data. Na from 136 to 132 mEq/L, K has changed from 3,7 to 2.8 mEq/L, Cl from 108 to 97 mEq/L, G from 126 to 79, CO2 from 25 to 31 mEq/L, BUN form 19 to 31 mg/dL and Cr from 1 to 1.6 mg/dL. What lab values are of concern to you and why? What are the reasons for these abnormal lab values? What signs and symptoms might the client experience because of these lab values? What are some appropriate nursing diagnoses for this client? What are some nursing interventions that you would provide based on the above lab values? What IV solution should this client be receiving? Is there any further electrolyte replacement required?

Explanation / Answer

The differential analyses includes conditions such as hyponatremia, hypokalemia, and metabolic alkalosis with an elevation of urine Na and cl absorptions. Hypopotassemia fundamentally eliminates SIADH condition. Both conditions such as hyperaldosteronism and Bartter’s condition does not cause noticeable hyponatremia. The elevated urine chloride eliminates symptom vomiting. In opinion of the client’s constant slow weakening the physician meets with the patient and her household and they decide to operation. A minor bowel resection is accomplished for a diagnosis of ischemic bowel. She stands the process well and improved fast from anesthesia in the post-anesthesia-care-unit. In the division her regaining was sluggish and stable. She departed home with her grandson on the 8th day post–operative without any further complications. After care was discussed with the patient and family. Patients with serious transient or slight ischemia have bodily findings deprived of peritonitis, a CT scan or mesenteric angiography representing perfusion to the bowels, and not at all indication for bursting width necrosis. If colonoscopy besides imaging propose lone mucosal to sub-mucosal participation, traditional events may be applied. These include:

-NPO application

-Fluid revival and likely inotropic provision

-Antibiotics

-NGT decompression to have patient a symptomatic relief.

No further elctrolyte replacement is required as the given fluids is adequate.

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