Course Title FUNDAMENTALS 

Scenario 

Sam, a 75-year-old patient with a history of chronic kidney disease (CKD) and hypertension, is admitted to the hospital with complaints of extreme fatigue, confusion, and shortness of breath. On assessment, the nurse notes that Sam has edema in the lower extremities and dry mucous membranes. Vital signs are as follows: blood pressure 160/90 mmHg, heart rate 102 bpm, respiratory rate 22 breaths/min, and temperature 98.2°F (36.8°C) Lab results indicate hyperkalemia (Potassium levels at 5.8 mmol/L), hyponatremia (Sodium levels at 130 mmol/L), and metabolic acidosis (bicarbonate levels at 18 mmol/L). 

Recognizing Cues 

Question: Which of the following cues are most relevant to assessing Sam's uid, electrolyte, and acid-base balance? (Select all that apply). 

-A. History of chronic kidney disease 

-B. Hypertension 

-C. Edema in lower extremities 

-D. Dry mucous membranes 

-E. Elevated potassium levels 

-F. Bicarbonate levels 

Answers: A. History of chronic kidney disease, B. Hypertension, C. Edema in lower extremities, D. Dry mucous membranes, E. Elevated potassium levels, F. Bicarbonate levels 

Rationale: A and B are critical because CKD and hypertension directly impact uid and electrolyte management and can contribute to Sam's current presentation. C (edema) and D (dry mucous membranes) oer direct evidence of uid imbalance. E (elevated potassium levels) and F (bicarbonate levels) are key lab ndings that signify electrolyte and acid-base imbalances, requiring immediate nursing interventions.

The nurse integrates Sam's medical history, physical assessment ndings, and lab results to identify critical cues. These cues provide a comprehensive picture of Sam's current health status, emphasizing the interplay between chronic conditions and acute changes aecting uid and electrolyte balance, as well as acid-base homeostasis. 

Analyzing Data 

Question: Considering Sam's condition, what is the most concerning lab result that needs immediate attention? 

-A. Hyperkalemia 

-B. Hyponatremia 

-C. Metabolic acidosis 

-D. Elevated blood pressure 

-E. Elevated heart rate 

-F. Respiratory rate 

Answer: A. Hyperkalemia 

Rationale: Hyperkalemia (Potassium levels at 5.8 mmol/L) is life-threatening and can lead to cardiac dysrhythmias. Given Sam's CKD, this risk is accentuated due to the kidneys' reduced ability to excrete potassium. Immediate action to lower potassium is crucial to preventing potential cardiac complications. 

The nurse evaluates Sam's lab results to determine which abnormality poses the greatest immediate risk to Sam's health, requiring urgent intervention. This decision is critical for prioritizing care actions to stabilize Sam's condition. 

Prioritizing Hypotheses 

Question: What should be the priority nursing diagnosis for Sam? 

-A. Excess Fluid Volume 

-B. Risk for Electrolyte Imbalance 

-C. Impaired Gas Exchange 

-D. Decreased Cardiac Output 

-E. Acid-Base Imbalance 

Answer: E. Acid-Base Imbalance

Rationale: Metabolic acidosis (indicated by bicarbonate levels at 18 mmol/L) is a direct consequence of CKD and contributes to Sam's fatigue and confusion. Addressing acid-base imbalance is essential for stabilizing Sam's condition, as it underlies many of the symptoms and has signicant implications for cardiac and overall health. 

Given Sam's complex presentation, the nurse must discern which issue, if addressed rst, could most signicantly impact Sam's overall stability. This prioritization is pivotal in developing an eective and timely care plan. 

Generating Solutions 

Question: Which intervention should be prioritized to address Sam's immediate needs? -A. Administer a potassium-lowering agent 

-B. Provide supplemental oxygen 

-C. Initiate sodium chloride infusion 

-D. Administer sodium bicarbonate 

-E. Implement uid restriction 

-F. Increase the rate of diuretics 

Answer: A. Administer a potassium-lowering agent 

Rationale: Given the immediate life-threatening nature of hyperkalemia, administering a potassium-lowering agent is the most direct and impactful intervention. This action targets the most dangerous imbalance, with the potential for rapid deterioration of Sam's condition. 

The nurse selects an intervention that directly targets the most critical aspect of Sam's imbalance. This choice must consider the risks and benets of each option, aiming to restore homeostasis with minimal adverse eects. 

Taking Action 

Question: After initial interventions, Sam's potassium level decreases, but he remains hypertensive and edematous. What is the next best nursing action? 

-A. Reassess uid and electrolyte status 

-B. Increase antihypertensive medication dosage 

-C. Apply compression stockings 

-D. Elevate the lower extremities 

-E. Consult a nephrologist for further evaluation

-F. Adjust the uid restriction protocol 

Answer: E. Consult a nephrologist for further evaluation 

Rationale: After addressing the immediate danger of hyperkalemia, consulting a nephrologist is crucial for comprehensive management of Sam's CKD, which is the underlying cause of his uid, electrolyte, and acid-base imbalances. 

A nephrologist can provide expertise in adjusting medications, managing CKD progression, and further rening treatment plans for electrolyte and acid-base management. The nurse evaluates the eectiveness of the initial interventions and decides on the next steps to further stabilize Sam's condition. This requires a dynamic and responsive approach, adapting to Sam's evolving needs. 

Evaluating Outcomes 

Question: After comprehensive management, which outcomes would indicate that Sam's uid, electrolyte, and acid-base balance have been successfully restored? (Select all that apply). -A. Normalization of potassium levels 

-B. Improvement in blood pressure 

-C. Reduction in edema 

-D. Improvement in respiratory rate 

-E. Normalization of sodium levels 

-F. Stabilization of acid-base balance 

Answer: A. Normalization of potassium levels, B. Improvement in blood pressure, C. Reduction in edema, D. Improvement in respiratory rate, E. Normalization of sodium levels, F. Stabilization of acid-base balance 

Rationale: Normalization of potassium levels (A) is crucial for cardiac stability. Improvement in blood pressure (B) and reduction in edema (C) indicate successful uid balance management. An improvement in respiratory rate (D) reects improved acid-base balance and decreased workload on the heart. Normalization of sodium levels (E). and stabilization of acid-base balance (F) indicate successful correction of electrolyte imbalances and metabolic acidosis, leading to overall health improvement. 

The nurse assesses a range of clinical indicators to determine the success of interventions aimed at correcting Sam's imbalances. Successful outcomes reect not only the resolution of acute issues but also the improvement in Sam's overall health status, enhancing quality of life and preventing future complications.

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