Discuss the Case Study of Mrs Fiona.
Mrs. Fiona is a 51-year-old woman who lives with her husband and a 22-year-old son in Sydney, Australia.She is suffering from Chronic Obstructive Pulmonary Disease (COPD) since twenty years and experiences various symptoms many times in a year. She is under medication of prednisone10 mg. Presently, COPD is under control. However, she is suffering from weakness and gets confused. Her husband also complains that she gets irritated easily now-a days. One day she was suffering from high fever of 102 degree Celsius, prolonged vomiting and diarrhea. Her husband called the doctor and was immediately asked to bring her to the hospital.
She was diagnosed with a high blood pressure of 130/90 and a pulse rate of 86. The concentration of fluids and electrolytes in the body was found after performing a lab test. The details are as follows:
Sodium : 151mmol/L (Normal range 135- 145 mmol/L)
Potassium : 2.9mmol/L (Normal range 3.5 - 5 mmol/L)
Chloride : 91mmol/l (Normal range 96-106mmol/L)
Calcium : 9.5 mg/dl (Normal range 8.2-10.2 mg/dl)
Magnesium : 1.5mmm/L (Normal range 1.3-2.1mmol/L)
Haemoglobin : 8g/dl (Normal range 12-16 g/dl)
Haematocrit : 25% (Normal range 38% to 47 %
Arterial Blood Gases Test (ABG Test)
pH level : 8 (Normal level 7.35-7.45 )
Partial Pressure of Oxygen : 64 (Normal level 75-100 mmHg)
Partial Pressure of Carbon dioxide : 45 (Normal Level 38-42)
Capillary Refill Test
Abnormal results were obtained in the patient after this test. This shows that the patient is suffering from dehydration (Normal -pink color in less than 2 seconds).
Total Urine Output
Sodium : High
Potassium : Low
Hypothetical Diagnosis and Outcome
Deficient Fluid Volume
Mrs. Fiona was suffering from excessive vomiting which lead to the removal of fluid and electrolytes from the body. She is suffering from hypernatremia as she has high level of sodium content and it occurs because of fluid loss. Hypokalemia is also observed in the patient as she has low level of potassium in the body and it occurs due to diarrhea and under the medication of steroids (Frenkel et al .2014).She is suffering from hypochloremia as she has low level of chloride concentration in the body. A high haematocrit volume is also observed which refers to elevated blood cell count in an abnormal manner and it occurs because of dehydration (Hooper et al. 2014).
ABG test reveals that the patient is suffering from high pH, high CO2 (Hypercapnia )and low O2 level in the arterial blood. Increase in pH occurs because of increased potassium and pulmonary disease and anemia
Risk for Infection
Since the patient is under the medication of prednisone, which is a corticosteroid, she is more prone to infection. Corticosteroids have a side effect that they reduce the immunity power of the body and lower the resistance to infection (Ciriaco et al. 2013).
Mrs. Fiona is suffering from hypokalemia and hypernatremia due to vomiting. Imbalance in the level of sodium and potassium has a negative effect on the central nervous system of the body and impairs the functioning of the brain (Welsh et al 2013).
Outcome: Level of sodium and potassium will be in normal limits in the body.
Rationale: Low level of sodium and potassium leads to various cardiovascular problems
Outcome: The patient will get rid of infection due to corticosteroids when hospitalized.
Rationale: Infection leads to stress on the low immune system of the body.
Potassium ,sodium and chloride are present in the gastric acid in the body and excess loss of these electrolytes can lead to metabolic alkalosis, dehydration, hypernatremia and hypoalkemia (Cook, Appel, and Whelton 2014).Monitoring and evaluation of fluid and electrolytes concentration in the patient should be done on a regular basis. If she is suffering from excess loss of potassium in the body, the pulse should be checked on a regular basis as it leads to various cardiac problems (Go et al.2014). She should be given various fluids and anti-vomiting medicines to prevent vomiting.
Practice Standards for Critical Care Nurses
Nursing interventions include weighing the patient on a regular basis and monitoring the blood pressure and pulse twice a day. Nurse should also keep a check on the loss of fluid and electrolytes in the body by vomiting or the output of urine. Daily observation of body temperature of the patient should be done. The patient should be given a proper balanced diet and fluids such as water and juices to increase the fluid content and hemoglobin level in the blood.(Camaschella 2015).She should be advised to avoid caffeine and alcohol as it hampers the electrolyte content in the body. The nurse should be sympathetic towards the patient and take care of her.
Reflective Assessment on Patient Assessment
The patient is stable, as she has received proper treatment on time. She was suffering from imbalance in fluid and electrolyte concentration in the body such as high sodium, low potassium and low chloride content. She was also diagnosed with high blood pressure, pulse rate, low hemoglobin high and a high haematocrit volume.Her ABG test revealed high CO2,low O2 and high pH.She should take proper rest and increase the intake of fluids such as water, juices and take a balanced diet to increase the hemoglobin level in the blood (Johnson et al. 2015).
Camaschella, C., 2015. Iron-deficiency anemia. New England Journal of Medicine, 372(19), pp.1832-1843.
Ciriaco, M., Ventrice, P., Russo, G., Scicchitano, M., Mazzitello, G., Scicchitano, F. and Russo, E., 2013. Corticosteroid-related central nervous system side effects. Journal of Pharmacology and Pharmacotherapeutics, 4(5), p.94.
Cook, N.R., Appel, L.J. and Whelton, P.K., 2014. Lower levels of sodium intake and reduced cardiovascular risk. Circulation, pp.CIRCULATIONAHA-113. Weber, M.A., Schiffrin, E.L., White, W.B., Mann, S., Lindholm, L.H., Kenerson, J.G., Flack, J.M., Carter, B.L., Materson, B.J., Ram, C.V.S. and Cohen, D.L., 2014. Clinical practice guidelines for the management of hypertension in the community. The journal of clinical hypertension, 16(1), pp.14-26.
Frenkel, W.J., van den Born, B.J., van Munster, B.C., Korevaar, J.C., Levi, M. and de Rooij, S.E., 2014. The association between plasma sodium levels at time of admission and mortality and morbidity in acutely admitted elderly patients: a prospective cohort study. Susceptibility to hyponatremia in the elderly: causes and consequences.
Go, A.S., Bauman, M.A., King, S.M.C., Fonarow, G.C., Lawrence, W., Williams, K.A. and Sanchez, E., 2014. An effective approach to high blood pressure control. Hypertension, 63(4), pp.878-885.
Hooper, L., Bunn, D., Jimoh, F.O. and Fairweather-Tait, S.J., 2014. Water-loss dehydration and aging. Mechanisms of ageing and development, 136, pp.50-58.
Johnson, E.C., Muñoz, C.X., Le Bellego, L., Klein, A., Casa, D.J., Maresh, C.M. and Armstrong, L.E., 2015. Markers of the hydration process during fluid volume modification in women with habitual high or low daily fluid intakes. European journal of applied physiology, 115(5), pp.1067-1074.
Welsh, D., Lennie, T.A., Marcinek, R., Biddle, M.J., Abshire, D., Bentley, B. and Moser, D.K., 2013. Low-sodium diet self-management intervention in heart failure: pilot study results. European Journal of Car