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Case Study 2

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1.      Ms. Morgan, age 74, had a stroke with paraplegia and aphasia. She requires assistance to eat and drink. In report you learn that yesterday her urine output totaled 300 cc.  What do you expect to happen to each of the following electrolytes?

 Na⁺       K⁺      Cl^-      Ca⁺⁺       Mg⁺             PO₄^-                

2.      Mr. Merrriweather, age 75, was admitted with the following lab values: Na⁺185, K⁺ 4.8, Cl^- 110, Ca⁺⁺ 8.2, Mg⁺ 2.0, PO₄^- 4.5. D5W is ordered at 200 ml X 2 hours. You have no history on this patient.

 Would you question the I.V. fluid order?  If yes, why?

    If you carried out the order, what will you watch for?

3.      Mr. Annan, age 40, is admitted with severe diarrhea for 3 weeks.  Over this period he was nauseated and ate poorly. History reveals a 30 pound weight loss over a 4 month period. Admission weight was 110 pounds. A small retroperitoneal fistula was found and repaired and a colostomy was performed.  One week later he was started on TPN. Labs at start of TPN: Na⁺136, K⁺ 3.6, Cl^- 93, Ca⁺⁺ 8.7, PO₄^- 3.4

 He has been on TPN for 8 days. In report you learn he was restless all night and complained of numbness and general weakness. During assessment you discover he is unable to lift his arms off of the bed and complains of pain whenever anything touches his skin. His speech is slurred and he has muscle twitching.

 You anticipate the labs to show

a.  hypocalcemia, hypomagnesemia and hypernatremia
b.  hypercalcemia, hypermagnesemia and hypernatremia
c.  hypocalcemia, hypophosphatemia and hypomagnesemia
d.  hypocalcemia, hypomagnesemia and hyperphosphatemia

4.      Mr. Rennack, age 18, sustained a C 4-5 fracture after diving into a creek during a party to celebrate high school graduation. What do you expect to happen to each of the following labs if he remains immobilized for 6 weeks?

 Na⁺         K⁺        Cl^-        Ca⁺⁺          Mg⁺                PO₄^-

 Which interventions will you institute to decrease these electrolyte changes?

5.      Ms. Hallamon, age 42, is post-op for removal of a larger adenoma from the chest wall.  The following lab results were obtained: Na⁺ 136, K⁺ 3.8, Cl^- 92, Ca⁺⁺ 12.8, PO₄^- 1.4. 

What does the lab work indicate?

 What nursing interventions will you institute based upon the above lab values?

6. Mr. Jeffery received 6 units of blood during surgery. Which electrolytes are you concerned about?

a.   magnesium and calcium
b.  sodium and phosphorus
c.  calcium and potassium
d.  sodium and magnesium 

7. Ms. Jones and baby Adam were discharged 2 days ago. Adam was 6 pounds, 7 oz on discharge. You are making the first postpartum visit. One of your goals is to determine how the breastfeeding is going. Ms. Jones mother-in-law is helping for the first 2 weeks. You find Adam difficult to arouse with poor muscle tone. He has a very weak cry. Weight is 7 pounds, 4 oz. No edema is present.  You are very concerned about Adam's lack of response. During your interview you discover that Ms. Jones is having difficulty getting Adam to breastfeed. She is supplementing his diet with water, because her mother-in-law told her that supplementing with milk would only discourage the baby from nursing. What fluid-electrolyte imbalance is occurring?

a. excess fluid and excess sodium
b. excess fluid and normal sodium
c. excess fluid and decreased sodium
d. normal fluid and excess sodium
e. normal fluid and normal sodium
f.  normal fluid and decreased sodium
g. decreased fluid and excess sodium
h. decreased fluid and normal sodium