Case Study #3 Jane Fonda Is a 74 year-old female who lives alone, and has been admitted to the hospital because of weakness and confusion. She has a history of chronic heart failure and chronic diuretic use. Objective Data: Neurologic: confusion, slow to respond to questioning, generalized weakness Cardiovascular: blood pressure90/62, heart rate112 and irregular, peripheral pulse is weak, EKG indicates sinus tachycardia Pulmonary respiration 12 per minute and shallow Additional findings: decreased skin turgor and dry mucous membranes Significant Laboratory Results: Serum Electrolytes: Sodium 141mEq/L Potassium 2.5 mEq/L Chloride 85mEq/L HC)3 43mEq/L BUN 42 mg/dl (15mmol/L) Arterial blood gas (ph 7.52, PaCO2 55mmHg PaO2 88mmHg HC)3 42mEq/L
QUESTIONS
1. Evaluate Jane’s fluid volume and electrolyte status. Which physical assessment findings support your analysis? Which laboratory results support your analysis? What is the most likely etiology of these imbalances?
2. Explain the rational for Jane’s EKG changes.
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