Case Scenario: Critical Judgement
A 55-year-old female is recently admitted to the ED. She has a history of DM, HTN, and atrial fibrillation. She has a complaint of excessive diarrhea, elevated temp. She is in moderate distress; her PE is normal. She is alert and oriented x 4 but appears fatigued. Her current vital signs are temperature 37.8 C (100.0 F), pulse 108 bpm, respirations 24 per minute, and blood pressure 189/106. Patient reports large volume of diarrhea x 4 days. In the handoff the nurse reports that the patient had an episode of diarrhea about 30 minutes ago
Her blood work was collected and resulted
Chemistry Patient Values Normal Values
Sodium 138 135-145mmol/L
Potassium 5.8 3.5-5mmol/L
Chloride 103 98-108mmol/L
Total C02 14 23-27mmol/L
Bun 16 7-22mg/dl
Creatinine 1.2 0.5-1.5mg/dl
Arterial Blood Gases
PH 7.29
PCO2 35
PO2 90
HCO3- 14
1. What findings are most significant?
2. What additional information is needed?
3. What questions would you ask the nurse giving the handoff? Why is this information important?
4. What patient problems/conditions/diagnoses are consistent with these findings?
5. What other assessment finding would you expect? Looking for Online Tutoring?
6. What additional information is needed to support your findings?
7. What is/are the critical course of events that is going to alter her acid-base status?
8. What Acid base abnormalities would you expect based on this information?
9. Review her blood gases. What is the primary acid-base abnormality? How did you decide that?
10. Is there a compensatory mechanism for this acid-base abnormality?
11. Is this a simple or mixed disorder? How did you come to that conclusion?
12. What clinical condition(s) is (are) responsible for the acid-base disturbance in this patient?