1 Which patient needs to be assessed first based on the info

1. Which patient needs to be assessed first based on the information above? Why?

2. What could be some possible causes of the hyperkalemia?

3. Patient B is also complaining of numbness and tingling, especially around the mouth. What are the other two electrolyte imbalances in this patient that could be causing these symptoms?

4. Discuss the possible etiology associated with each electrolyte imbalance identified in question number 3.

5. What manifestations are associated with the three electrolyte imbalances in Patient B?

6. How would you interpret Patient B’s arterial blood gases?

7. What body system will attempt to compensate?

A nurse has just been assigned to care for three patients: A, B, and C. Selected lab work for each patient is listed below. Patient C Patient A Patient B Expand side panel 138 mEq/L. 142 mEq/L. 148 mEq/L. Na 5.1 mEq/L 6.1 mEq/L 3.8 mEq/L 7.5 mg/dL. 9.5 mg/dL Cat 8.9 mg/dL. 2.1 mg/dL. 1.3 mg/dL. 0.9 mg/dL. Mg 7.42 7.32 pH 7.40 PCO2 42 mm Hg 48 mm Hg 40 mm Hg PO2 95% 98% 99% HCO3 28 26

Solution

The nommal value of electrolytes is

1. Patient B has abnormal reading for pCO2, Mg+, K+, ca +2 and HCO3 and hence patient B should be assesed first. This is because his electrolyte balance is abnormal and pCO2,HCO3 are elevated.High pCO2 and cause respiratory acidosis which might cause choking and airway obstruction which can be fatal. High K+ leads to cardiac arrest.

2. Hyperkalemia is defined as a high serum potassium concentration greater normal value of 3.5-5 mEq/L . Hyperkalemia can result due to excessive intake, Decreased excretion and a shift of potassium from the intracellular to the extracellular space

3) High Potasium and sodium causes numbness and tingling.

5) Hyperkalcemia causes numbness, tingling and weakness

hypernatremia causes Muscle spasms,Muscle tremors,Irritability,Excessive sleepiness,Lethargy and sometimes Coma.

Magnesium: 1.5-2 mEq/L

Potassium: 3.5-5 mmol/L

Sodium: 135-145 mmol/L

Total calcium: 2-2.6 mmol/L

HCO3 22-26 mEq/L

pO2 : 80-100 mmHg

pCO2 : 35- 45 mm Hg

pH 7.35 -7.45