Case Study #2, Fluid and Electrolyte and Acid-Base Imbalances
Conrad Jackson is a 28-year-old man who presents to the emergency department with severe fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he "ate something bad." Upon admission his vital signs are a temperature of 102.7°F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas.
The following results are returned from the laboratory:
Sodium (Na+) 150
Potassium (K+) 5.5
Chloride (Cl¯) 110
BUN 42
Creatinine 0.8
Glucose 86
pH 7.32
PaCO2 35
HCO3¯ 20
PaO2 90
O2 Sat 98%
What is your interpretation of this arterial blood gas sample?
Explain the high potassium in this patient (Review history and correlate those symptoms to why his potassium is high).
Explain why the physician ordered 0.45% normal saline.
What other orders might you expect from the provider?
What is the Priority Nursing Diagnosis for this patient?