NUR 641E WK3 Case Study

Introduction

This paper discusses the laboratory findings of an 85-year-old woman from a hospital-based skilled nursing facility who was lethargic, had a decreased output of urine, a warm and dry skin. It describes the electrolyte imbalance, clinical manifestations, and blood gas abnormality the patient had, and the major mechanisms of pH regulation. This knowledge is important for nurses to be able to identify and determine the underlying causes of electrolyte imbalance in patients and intervene appropriately to maintain a healthy functional status. NUR 641E WK3 Case Study

Abnormal Laboratory Findings

The human body has normal ranges of parameters that are controlled homeostasis. However, pathologies occur due to various factors that cause an imbalance in the parameter ranges. Deviations from the name into are classified into conditions whose management involves restoring the imbalanced changes to normal ranges. The average sodium level is 135-145. However, since this client’s sodium levels are 147, he has hypernatremia (Tazmini et al., 2019). Chloride levels should range between 97-107 mEq/L. The client’s lab result (Cl: 110) indicates that she has hyperchloremia. The average range of partial pressure of carbon dioxide (PCO₂) is 35-45mmHg. The patient’s PCO₂ finding (48mmHg) indicates that the patient has acidosis (Tazmini et al., 2019).  The specific gravity of urine is 1.002-1.030. The patient’s urine specific gravity of 1.040 indicates mild dehydration.

Condition Each Abnormality Indicates

The client has hypernatremia caused by sodium imbalance (Na: 147). Hypernatremia is a sign of dehydration caused by renal dysfunction, medications (diuretics), inability to take water, and vomiting. Thus, she is likely to complain of excessive thirst as the body tries to replace water molecules lost in the kidney tubules due to high sodium levels. The patient is also likely to manifest with a headache, which is caused by pressure build-up in the blood vessels as the volume of the blood increases (Tazmini et al., 2019). Hypernatremia also presents with lethargy and confusion, which the nurse should assess and manage to avoid hospital falls. Hyperchloremia is caused by chloride electrolyte imbalance and commonly manifests with hypernatremia. Tazmini et al. (2019) highlight that, it can also occur with conditions that cause hypernatremia such as renal disease or Cushing syndrome. The client also presents with dry mucus membranes due to the loss of excess water in the kidneys.

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The normal potassium level ranges between 3.6-5.2 mmol/L and when the amount goes high above that the patient is said to have hyperkalemia. The patient presents with symptoms like lethargy and tiredness that prevent them to complete even simple actions. High potassium levels impact the excitation state at the cellular level thus inhibiting basic action potential (Rajkumar & Pluznick, 2018). All the body cells are affected including cardiac muscles thus interfering with the pumping mechanism. High potassium level affects the nervous where the nerves firing action potential to the brain is inhibited. Therefore, the client presents with symptoms like numbness and tingling. The cardiac muscle function is inhibited resulting in symptoms like palpitations or an increased heartbeat. The imbalanced electrolyte also impacts lung function that presents as difficulty in breathing when the cells are deprived of oxygen (Oun & Rowan, 2017). Thus, the nurse should monitor for fluid imbalance and severe dehydration. The care provider should also monitor blood gases, which are likely to be impaired due to lung function. NUR 641E WK3 Case Study

The partial pressure of carbon dioxide in the blood is above the normal range (35-45mmHg) thus, the client has acidosis since her lab results indicate 48mmHg. Her pH is also below the normal range of 7.35-7.45 since her lab result indicates 7.33. Low pH levels in the body lead to symptoms like lethargy, tremors, confusion, and headaches (Leclercq & Leclercq, 2019).

Specific Electrolyte Imbalance with Clinical Manifestations

The patient in this case has hypernatremia and dehydration. Hypernatremia results in confusion, an altered mental state, and hypotension. Hypernatremia increases the osmotic concentration in the vascular system causing a fluid shift from interstitial and intracellular space to vascular space as a mechanism for volume replacement (Tazmini et al., 2019). The movement of fluids from the interstitial and cellular space influence dehydration.

Clinical Manifestations to Monitor For With Hyperkalemia

Increased potassium levels in blood is referred to as hyperkalemia. Hyperkalemia causes cardiac arrhythmias and respiratory weakness. According to Oun & Rowan (2017), the clinical manifestations that a nurse should monitor include vomiting and nausea, fatigue, trouble breathing, chest pain, irregular heartbeat, and palpitations. NUR 641E WK3 Case Study

Blood Gas Abnormality and Ph Regulation Mechanisms

Since this patient as a blood pH of 7.33 (7.35-7.45), it is right to conclude that he has acute uncompensated primary respiratory acidosis. This abnormality develops following the lung’s inability to remove CO_2. As highlighted by Oun & Rowan (2017), continuous accumulation of CO₂ reduces the blood’s pH making it to be too acidic. The three mechanisms for regulating the Ph of body fluids are renal, buffers, and respiratory system. The body tries to regulate the pH through three major mechanisms. One of the mechanisms is the buffer systems including the proteins, which have both acidic and basic characteristics, thus they can receive or donate hydrogen ions to balance the ph. Other buffers include phosphate and hydrogen carbonates. The body also regulates blood pH through respiration where the lungs release higher levels of carbon dioxide during exhalation when the pH is low. According to Rajkumar & Pluznick (2018), when the body is experiencing alkalosis, the body retains CO2 during exhalation to lower the ph. The body also corrects blood pH levels through renal clearance where extra CO2 is excreted together with urine. NUR 641E WK3 Case Study

References

Leclercq, F., & Leclercq, B. (2019). Hypokalemic Metabolic Alkalosis. In StatPearls [Internet]. StatPearls Publishing.

Oun, R., & Rowan, E. (2017). Cisplatin-induced arrhythmia; electrolyte imbalance or disturbance of the SA node?. European Journal of Pharmacology, 811, 125-128.

Rajkumar, P., & Pluznick, J. L. (2018). Acid-base regulation in the renal proximal tubules: Using novel pH sensors to maintain homeostasis. American Journal of Physiology-Renal Physiology, 315(5), F1187-F1190.

Tazmini, K., Nymo, S. H., Louch, W. E., Ranhoff, A. H., & Øie, E. (2019). Electrolyte imbalances in an unselected population in an emergency department: A retrospective cohort study. PloS one, 14(4), e0215673. NUR 641E WK3 Case Study