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?