A middle-age male patient arrived at the Emergency Department with a one-week hi

Question

A middle-age male patient arrived at the Emergency Department with a one-week history of a “stomach bug” characterized by extreme fatigue, persistent nausea and frequent, watery diarrhea. His only medications were metoprolol 50 mg b.i.d. and hydrochlorothiazide 25 mg daily for hypertension. Until this episode, the patient had been in relatively good health. Evaluation in the Emergency Department revealed the patient to have a pulse of 130, B/P of 78/50, respirations of 26, creatinine of 8, potassium of 2.8 and sodium of 150. Arterial blood gases revealed a pH of 7.28, PCO2 of 45, and HCO3 of 20. He was admitted emergently to the Intensive Care Unit. List two (2) suitable nursing diagnoses for this patient. Which specific nursing assessments and interventions will be needed for these diagnoses? Discuss factors that likely contributed to his altered vital signs and abnormal lab values. What specific acid-base imbalance is evident in this patient? What criteria would be used to determine if the therapy is successful? What type of IV therapy might be used to restore this patient’s fluid and electrolyte balance?

Explanation / Answer

As the patient is suffering from diarrhea since one week, loss of fluid decreases his blood volume and electrolyte levels. The decreased blood volume results in decreased blood pressure and increased pulse rate. The rate of respiration is increased to meet the oxygen demands. Muscle weakness decreases the forced expiratory volume (FEV), which increases blood PCO2 levels, causing respiratory acidosis (normal blood pH is 7.4).

1). The patient is suffering from respiratory acidosis. The increased CO2 levels decreased the blood pH by producing more bicarbonate ions.

2). Restoration of blood pressure, blood pH and creatinine levels to the near normal levels would be indicative of successful therapy.

3). IV administration of electrolytes and dextrose can help to restore the patient’s fluid and electrolyte balance.

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