Fluid and Electrolytes: Balance and Disturbance

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Scenario:

Conrad Jackson is a 28 year old whom presents to the er with severe fatigue and dehydration secondary to 4 day history of vomiting. Upon admission his v/s are T=102.7, hr =116 bpm, rr=18, bp=8/54. Pt has dry mucus membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and oders serum electrolytes and ABG.

The foll results are from the Lab

Na=150

K=5.5

Cl-= 110

BUN 42

Creatinine 0.8

Glucose 86

pH 7.32

PaCO2 35

HCO3 20

PaO2 90

O2Sat 98

What is your interpretation of ABG

Explain the high K in this pt

Calculate the patient anion gap

What is the interpretation of this anion gap

Can anyone help me with this scenario?

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What are your thoughts?

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Specializes in Complex pedi to LTC/SA & now a manager.

Big problems if BP is 8/54 as that is physiologically impossible.

We are happy to help and guide but not going to do your homework for you.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Scenario:

Conrad Jackson is a 28 year old whom presents to the er with severe fatigue and dehydration secondary to 4 day history of vomiting. Upon admission his v/s are T=102.7, hr =116 bpm, rr=18, bp=8/54. Pt has dry mucus membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and oders serum electrolytes and ABG.

The foll results are from the Lab

Na=150

K=5.5

Cl-= 110

BUN 42

Creatinine 0.8

Glucose 86

pH 7.32

PaCO2 35

HCO3 20

PaO2 90

O2Sat 98

What is your interpretation of ABG

Explain the high K in this pt

Calculate the patient anion gap

What is the interpretation of this anion gap

Can anyone help me with this scenario?

We are happy to help....tell us what you think first and we will jump right in.

What do you know about dehydration? What does that do to the potassium and other electrolytes? What happens with vomiting? how does this affect electrolyte and hydration?

Take a look at this thread then tell me what you think.

https://allnurses.com/nursing-student-assistance/really-need-help-826428.html

I learned ABG's using ROME.

ROME:

Respiratory= Opposite:

- pH is high, PCO2 is down (Alkalosis).

- pH is low, PCO2 is up (Acidosis).

Metabolic= Equal:

- pH is high, HCO3 is high (Alkalosis).

- pH is low, HCO3 is low (Acidosis)

and......ABG tic tac toe......

VickyRN I've attached a "tic-tac-toe" type handout I made for my students when I teach ABG's. Hope this helps :)

paperclip.png Attached Files

Now tell me what you think.
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https://allnurses.com/nursing-student-assistance/fluid-and-electrolytes-885838.html

#3

https://allnurses.com/nursing-student-assistance/acid-base-balance-898777.html

#3

Now, when you've finished with these, let's see what your interpretation of your scenario is. Still unclear somewhere? Ask us about your particular point.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
https://allnurses.com/nursing-student-assistance/fluid-and-electrolytes-885838.html

#3

https://allnurses.com/nursing-student-assistance/acid-base-balance-898777.html

#3

Now, when you've finished with these, let's see what your interpretation of your scenario is. Still unclear somewhere? Ask us about your particular point.

LOL I posted one of your famous posts too!

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