You are working as a nurse on a Medical Surgical unit and receive a call from an outpatient clinic notifying you of a direct admission. The estimated time of arrival is approximately one (1) hour. She gives you the following information:
PB is an 87 year-old woman with a three day history of intermittent abdominal pain, abdominal bloating and nausea and vomiting.
PMH is significant for a colectomy for colon cancer six years ago, ventral hernia repair two years ago. No history of heart disease, diabetes or pulmonary disease. She takes only ibuprofen occasionally for mild arthritis. Allergies include sulfa drugs and meperidine. PB's tentative diagnosis is small bowel obstruction (SBO) secondary to adhesions. PB is admitted to your floor for diagnostic work-up. Her VS are stable, HR 75, BP 110/72, RR 14, SpO2 98%on3L, T 98.9 she has an IV of 1000 mL D5½ NS with 20 mEq KCl at 100 mL/hr, and O2 @ 3L per NC.
After 3 days of NGT suction, PB's symptoms are unrelieved. She reports continued nausea, crampiness, and sometimes very strong abdominal pain; her hand grips are weaker; and she seems to be increasingly lethargic. You look up her latest laboratory values and compare them with the admission data. Her sodium has changed from 136 to 130 mmol/L, potassium has changed from 3.7 to 2.5 mmol/L, Chloride from 108 to 97 mmol/L, glucose 126 to 65 mg/dL. Her ABG's are as follows: pH 7.52, CO2 46, HCO3 32