Sent by you: In the Demographic Site Analysis, you identified

W.D. is a 65-year-old Asian woman who has arrived in the emergency room complaining of severe abdominal pain. She states a three-day history of increasing abdominal pain, increasing girth and nausea. She vomited stomach contents up to two days ago, but now vomits only greenish bile. She has never had a screening colonoscopy. She states she has not passed stool or flatulence for the past two days. Vital signs are BP 180/95; HR 120 bpm; Respirations 25 and shallow; Temperature 100.3 deg F; Pain is 9/10. Abdomen is distended but W.D. does not have muscle guarding or rebound tenderness on palpation. On auscultation, bowel sounds are absent in all 4 quadrants. Client had a remote ventral hernia repair, and the tentative diagnosis is a small bowel obstruction (SBO) due to adhesions. The physician orders are for IV infusion of D5 0.5NS with 20mEq KCl at 100 mL/hr., 2 L oxygen by nasal cannula, and insertion of a Salem Sump nasogastric tube with intermittent low wall suction. After two days, W.D.’s symptoms are unrelieved. She continues to complain of nausea, cramps, and significant abdominal pain. Drainage into the NG container is of green watery fluid and draining 250 ml/hour. She appears paler and states she “feels very weak.” Review of recent lab values and trending with admission labs are as follows: Test Admission Hospital Day 3 Na 136 mEq/LL 130 mEq/L K 3.7 mEq/L 2.5 mEq/L Cl 108 mEq/L 97 mEq/L BUN 19 mg/dL 38 mg/dL Creatinine 1 mg/dL 2.2 mg/dL Glucose 126 mg/dL 65 mg/dL Albumin 3.0 g/dL 3.1 g/dL Protein 6.8 g/dL 4.9 g/dL pH 7.44 7.47 PaCO2 38 mm Hg 33 mm Hg HCO3 28 mEq/L 23 mEq/L PaO2 75 mm Hg 65 mm Hg Answer the following questions in your initial post: 1. What lab value is of most concern to you. List concerning labs and whether each is a result of fluid, electrolyte, or acid-base imbalance. 2. What type of acid-base imbalance is determined from the labs? Is the acid-base imbalance uncompensated, partially compensated, or compensated? 3. What electrolyte imbalances are contributing to the development of the acid-base imbalance? What other complications can electrolyte imbalances lead to? 4. As the client has not had nutrition provided to her over the past three days, what labs are demonstrating poor nutritional status? 5. What treatment(s) are contributing to fluid, electrolyte, and acid-base imbalances? 6. To address the fluid, electrolyte, and acid-base imbalances, what are two priority nursing interventions?

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