AUBREY ROSE A.
VIDON September 18, 2020
BSN 3Y1 - 2
COURSE TASK #3
Study Questions:
ELECTROLYTE IMBALANCES:
Several patients were admitted in the medical ward. Answer the following questions pertinent to the
patients’ conditions.
PATIENT A – Presented in the emergency department with severe headache, irritability, and tremors
after finishing a full marathon. Laboratory values reveal Serum sodium level of 130 mEq/L.
PATIENT B – Presented in the emergency department with severe body malaise, diminished bowel
sounds, and ECG reveals an extra U-wave in the tracing after 8 bouts of watery diarrhea. Laboratory
values further reveal a Serum potassium level of 3.0 mEq/L.
PATIENT C – A post thyroidectomy patient presented with severe muscle cramps and prolongation of
QT-interval in the ECG and was referred to the medical consultant for co-management. Serum calcium
level is 4.0 mEq/L.
PATIENT D – A patient receiving magnesium for the management of seizure disorder suddenly
presented with depressed deep tendon reflex and becomes stuporous. Laboratory values reveal a
Serum Magnesium level of 2.6 mg/dL.
1. Given the Patient B’s presentation, trace the pathophysiological cause of the decrease in serum
potassium level.
Answer:
Potassium, the most abundant intracellular cation, is essential for the life of an organism. Potassium
homeostasis is integral to normal cellular function, particularly of nerve and muscle cells, and is tightly
regulated by specific ion-exchange pumps, primarily by cellular, membrane-bound, sodium-potassium
adenosine triphosphatase (ATPase) pumps.
Potassium is obtained through the diet. Gastrointestinal absorption of potassium is complete, resulting
in daily excess intake of approximately 1 mEq/kg/day (60-100 mEq). Of this excess, 90% is excreted
through the kidneys, and 10% is excreted through the gut.
Potassium homeostasis is maintained predominantly through the regulation of renal excretion; the
adrenal gland and pancreas also play significant roles. The most important site of regulation is the renal
collecting duct, where aldosterone receptors are present.
Potassium excretion is decreased by the following factors:
Absolute aldosterone deficiency or resistance to aldosterone effects
Low sodium delivery to the collecting duct
Low urine flow
Low serum potassium levels
Renal failure
An acute increase in osmolality causes potassium to exit from cells. An acute cell/tissue breakdown
releases potassium into extracellular space.
2. What will be the emergency medication that should be readily available in managing the
disorder apparent for Patient D?
Answer:
Buccal (oromucosal) midazolam – is given into the buccal cavity (the side of the mouth between the
cheek and the gum).
Rectal diazepam – is given rectally (into the bottom).
3. Explain the relationship of thyroid surgery and the development of hypocalcemia in Patient C.
Answer:
Hypocalcemia is a major post-operative complication of total thyroidectomy, causing severe
symptoms and increasing hospitalization time. The primary cause is secondary hypo-parathyroidism
following damage to, or devascularisation of, one or more parathyroid glands during surgery.
4. Explain the relationship of Patient A’s prior activity and the development of hyponatremia.
Answer:
While extremely rare, this condition has caused death during or after running long runs or
marathons. Many runners become overly concerned about hyponatremia, and don't drink enough
before during and after a long run. A substantial portion of runners have abnormally low serum sodium
concentrations after completing a marathon. Excessive consumption of fluids, as evidenced by
substantial weight gain while running, is the single most important factor associated with hyponatremia.
5. Explain the mechanism behind the development of prolonged QT –interval for Patient C.
Answer:
The mechanism of drug-induced prolonged QT interval involves inhibition of the rapid component of
the delayed rectifier potassium current (IKr). Blocking IKr leads to prolongation of the ventricular action
potential duration, leading to an excess sodium influx or a decreased potassium efflux.
6. Enumerate at least one (1) nursing diagnosis for Patient A, B, C, and D.
Answer:
Patient A – Hyponatremia
Patient B – Hypokalemia
Patient C – Long QT Syndrome
Patient D – Seizure Disorder
ACID-BASE IMBALANCES:
Multitude of patient’s conditions can predispose them to different acid-base imbalances. Several
patients were admitted in the medical-surgical ward and are put under your care. Answer the following
questions pertinent to the patients’ conditions.
PATIENT A – admitted in the medical ward 30 minutes ago with chief complaint of severe dizziness and
vertigo accompanied by frequent vomiting. As the patient moves, vomiting follows which is now
recorded to be 7-8 times from the time of admission. Diphenhydramine 1 ampule TIV and
metoclopramide 1 ampule TIV as stat doses were given to the patient.
PATIENT B – a dialysis patient who has stopped attending his dialysis session was admitted in the ward
due to changes in sensorium. Serum creatinine level is elevated as well as the Blood Urea Nitrogen
(BUN). Shallow respiration is noted upon the assessment of the patient.
PATIENT C – a patient was rushed to the emergency department and later was admitted to the ward
with chief complaint of shortness of breath, numbness and tingling around mouth and fingers, and
lightheadedness after taking a major examination in school. The patient was offered a brown bag by the
admitting nurse.
PATIENT D – A patient with emphysema as admitted in the ward due to difficulty of breathing. The
patient appears reddish and is complaining of lightheadedness. The patient was immediately hooked to
oxygen therapy at 2 Lpm.
Choose from the following ABG results which will be consistent with the patient’s condition:
A. pH 7.50 PaC02 31 HCO3 17
B. pH 7.30 PaC02 30 HCO3 18
C. pH 7.48 PaC02 49HCO3 30
D. pH 7.32 PaC02 50 HCO3 28
1. Patient A: D
2. Patient B: C
3. Patient C: B
4. Patient D: A
5. Explain why Patient B presented with shallow respiration in relation to the patient’s condition.
Answer:
Several conditions are marked by, or are symptomatic of, shallow breathing. The more common of
these conditions include: various anxiety disorders, asthma, hyperventilation, pneumonia, pulmonary
edema, and shock. Anxiety, stress, and panic attacks often accompany shallow breathing.
6. Explain why Patient D experiences lightheadedness and why the patient appears reddish in
relation to the patient’s condition.
Answer:
That could be a warning sign of COPD. When your lungs don't work properly, you don't get enough
oxygen while you are asleep, and carbon dioxide builds up in your blood. Waking up feeling lightheaded
or dizzy could also be a sign of COPD.
7. Explain the purpose of offering brown bag to Patient C as an emergency management for the
patient’s condition.
Answer:
When you lose a significant amount of CO2 due to hyperventilation, the tissues in your body can
start to malfunction. The idea behind breathing into a paper bag is that rebreathing exhaled air helps
your body put CO2 back into your blood.
8. Create a drug study for the medication: METOCLOPROMIDE specifying the following:
Drug classification
Mechanism of action
Indication (*for the case of the patient mentioned above)
Contraindication
Side effects
Nursing Considerations
Drug classification Prokinetic Agents
Mechanism of action Metoclopramide works by antagonizing central and peripheral dopamine two
receptors in the medullary chemoreceptor trigger zone in the area postrema
that are normally stimulated by levodopa or apomorphine.
Indication Metoclopramide is a dopamine antagonist that also enhances gastrointestinal
(GI) tract motility and accelerates gastric emptying. It has been associated
with lightheadedness, drowsiness, headache, GI upset, diarrhea, and muscle
weakness. It is commonly used to treat and prevent nausea and vomiting, to
help with emptying of the stomach in people with delayed stomach emptying
Contraindication Metoclopramide is contraindicated in pheochromocytoma. It should be used
with caution in Parkinson's disease since, as a dopamine antagonist, it may
worsen symptoms. Long-term use should be avoided in people with clinical
depression, as it may worsen one's mental state.
Side Effects Headache
Confusion
Trouble sleeping
Dizziness
Restlessness
Sleepiness
Exhaustion
Nursing Considerations Assess for extrapyramidal symptoms and tardive dyskinesia (more
likely in older patients). –
Assess for gastrointestinal complaints, such as nausea, vomiting and
constipation.
In oral administration, for better absorption allow 30 minutes to one
hour before eating.
Rinse mouth frequently to combat dryness.
