Clinical Case Decisions
CLINICAL CASE DECISION INSTRUCTIONS
SELECT TWO CASES FROM THE FOLLOWING.
Your comments should be substantive and substantiated. Postings require two citations from 1 scholarly journal and 1 from the course textbook.
To gain full credit for the assignment, each case must be at least 1 page, but no more than three (3) pages in length. The title and reference pages are NOT included in this count.
APA format required- proper citations and references.
Select two cases for this assignment.
Clinical Decision Cases
There are five cases listed below; begin with a focused exam assessment, you decide if it should be treated as episodic with rationale for each case. Each area should be under a separate heading.
Select two cases to provide analysis. All cases should include the following, use a heading for each topic.
a. Pathophysiology and pharmacology of the disease-Heading
b. Expected signs and symptoms of the disease.-Heading
c. Nursing Diagnosis with a plan of care. Heading required
d. All questions pertaining to the case as listed under each case. Heading required
C1. Mr. Appel has a severe chronic obstructive pulmonary disease (COPD). He is admitted to the hospital with a respiratory infection and increased dyspnea; yellow, purulent sputum; anxiety; and diaphoresis. He states he feels weak and tired. He routinely takes a diuretic (furosemide) and his pulmonary medications. The following laboratory values are obtained:
Arterial blood gases:
pH 7.25 Serum sodium (Na+) 140 mEq/L
PaO2 60 mmHg Serum potassium (K+) 2.0 mEq/L
PaCO2 78 mmHg Serum chloride (Cl) 105 mEq/L
HCO3 34 mEq/l
a. What type of electrolyte imbalance does Mr. Appel have?
b. Interpret his ABGs.
C2. Mr. Jones is admitted to the hospital with an exacerbation of heart failure. He has +3 peripheral edema of the lower extremities.
a. What are the possible causes of his peripheral edema?
C3. Carl is a 15-year-old admitted to the hospital following a closed head injury during a motor vehicle crash. He is diagnosed with syndrome of inappropriate anti-diuretic hormone (SIADH).
a. You would monitor him for what signs and symptoms?
C4. Identify the intracellular and plasma buffer systems and discuss how they function.
C5. Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:
Serum glucose 412 mg/dl
Serum sodium (Na+) 156 mEq/l
Serum potassium (K+) 5.6 mEq/l
Serum chloride (Cl) 115 mEq/l
Arterial blood gases (ABGs):
pH 7.30; PaCO2 32 mmHg; PaO2 70 mmHg; HCO3 20 mEq/l
a. What type of water and solute imbalance does Ms. Brown have?
b. What do her ABG results indicate?
c. Does she have an anion gap and what does this indicate?