CASE STUDY 1 You are the emergency

CASE STUDY 1 You are the emergency department RN taking care of a patient. Mr. Payne is 85 and has had severe vomiting for 3 days. He is feeling dizzy and “very tired”. He states he is very thirsty but is “unable to keep anything down” and aches “all over”. PMH: HTN, “heart problems” Exam: HR 105, B/P 95/30 R 20, T 100 Dry mucous membranes, unsteady gait Pertinent lab values are: Elevated NA+, HCT Decreased Bicarb High Urine Specific Gravity pH 7.46 1. What is his Fluid balance? 2. Which fluid compartments are likely to be affected at this time? 3. Describe the signs of his dehydration. What other signs might we see? 4. How would you describe his acid/base status now? Why is this likely occurring? 5. Describe the compensations for the loss of fluid that should be occurring? 6.Describe what other possible electrolyte abnormality we could expect to see? 7.How does high serum sodium levels affect the intracellular fluid? 8What is the role of the Kidneys in this situation? 9After a long sustained period of vomiting, what would we expect to see in regards to his Acid/Base status? Why is this taking place? SCIENCE HEALTH SCIENCE NURSING RNSG 1533

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