Mrs. Anderson is asymptomatic when she is allowed to drink massive volumes of water. She has been recently moved to a supervised care facility where her water intake has been drastically limited. Upon physical exam Mrs. Anderson’s skin is wrinkled, shows dry mucous membranes, disorientation, lethargy and confusion. Mrs. Anderson’s vital signs included a blood pressure of 70/55, heart rate of 124 beats per minute. Her blood plasma osmolality is 380mOsm/kg, sodium of 152 mEq/L, BUN of 36mg/dL, creatinine of 2.1mg/dL and a lithium level of 1.9mEq/L.
1. What is happening to Ms. Jones’s kidneys, and why is it causing the observed symptom? Ms. Jones’ kidneys are not working. She has little urine output According to Healthwise (2011), “When your kidneys stop working, waster products, fluids, and electrolytes build up in your body”(para. 1) 2.
Failure of one chamber causes reciprocal changes in the opposite chamber; Weakness and fatigue; Poor feeding, resulting in weight loss; Developmental delays; Irritability; Pallor and cyanosis; Dyspnea, tachypnea, orthopnea, wheezing, cough, weak cry, grunting, mild cyanosis and coastal retractions; Tachycardia; Hepatomegaly; Weight gain from edema, ascites and pleural effusion; Distended neck and peripheral veins; Sweating Nursing Diagnosis: Activity intolerance r/t generalized weakness; imbalance between oxygen supply and demand Goal: Participates in prescribed physical activity with appropriate increases in heart rate, blood pressure, and breathing rate Nursing Interventions and
C) Hyperreflexic deep tendon reflexes. Feedback: INCORRECT Initially, flaccid paralysis occurs, resulting in hyporeflexic deep tendon reflexes. D) Decreased bowel sounds. Feedback: INCORRECT The bowel sounds are not indicative of a brain attack. E) Difficulty swallowing.
This condition is common among females that have a history of menorrhagia, or heavy menstrual flow (Mayo Clinic, 2014). Hallmark symptoms of iron deficiency anemia include low energy, shortness of breath, dizziness, and abnormal lab values like low hemoglobin and hematocrit, low erythrocytes, and immature red blood cells (Cafasso, 2012). Ms. A demonstrates all of these symptoms. Her hemoglobin, hematocrit, and erythrocyte counts are all low and the presence of microcytic and hypochromic red blood cells indicate immaturity of cells. Her
Starving to death Questions: 1. The physical changes: You lose weight and you can die if you lose enough weight. Tibi is pale, tired and in pain and she has visible veins. The mental changes: You are not yourself, and the anorexia takes control of your life and your mind. Tibi has really low self esteem, and she doesn’t laugh and have fun anymore.
Anemia is associated with chronic fatigue, impaired cognitive function, and diminished well-being. This type of anemia is seen very often in women and people that have a poor diet low in iron, women with heavy menstrual cycle, pregnant or after recent births, breast feeding, its seen in individuals that had recent major surgery, GI disease, peptic ulcers, gastric bypass patients, Crone’s disease and vegetarians and individuals with poor iron-rich intake (Jimenez, Dabsch & Gasche, 2015).. Ms. A should be admitted to the hospital for couple days, placed on oxygen therapy, type and cross for identifying the blood type she needs, obtain IV access with a large bore catheter for possible RBC transfusion, normal saline for fluid resuscitation and iron injections or IV iron therapy could be ordered by the physician. Repeated laboratory testing should be done post transfusion and periodically while in the hospital. Also knowing that Ms. A takes large dosages of aspirin, continued monitoring for any active bleeding internally, imaging testing (abdominal ultrasound, CT scan), occult blood should be done and also
Sx: Pertinent positives, sx that raise suspicion for the dz Pert. Neg. : Pertinent negatives, sx lower suspicion for dz Assoc. Med: Medications related to the dz PE: common PE findings assoc with the disease Dx by: How dz is diagnosed/ruled out Scribe Alert: important info I should know General Dehydration (major DDx) Etiology: shortage of fluids in the body most commonly caused by vomiting/diarrhea. May be caused by Long periods of poor PO intake CC: Lethargic/Listless, Sunken Eyes, Poor UOP (urine output) PE: DMM (dry mucous membranes), cries w/o tears, sunken fontanel or eyes, tachycardic, poor skin tugor Dx by: Clinically, Na+ from basic metabolic panel ScribeAlert: UOP best indicator, always document how frequent patient makes wet diapers.
Once again elderly females are more likely to end up with osteoarthritis than males. (Swift,(2012) Muscular atrophy is a third problem common in the elderly. This is simply a loss of muscle mass due to a lack of physical activity. (Evans, (2010) Pain, stiffness, and injury can lead to an inability or unwillingness to perform normal daily chores. As the muscle atrophies it becomes increasingly weaker.
Levels which are considered to be within normal limits for a female are between 11.5 to 16.5g/dL. Mrs Jones haemoglobin levels are considerably lower than specified and suggest that she may be suffering from Anemia. Given that the patient is preparing for surgery, the rationale behind her transfusion may be her Anemia. (Brown, D., & Edwards, H. 2008). Fluid resuscitation refers to the medical practice of replenishing body fluids lost via bleeding, sweating, etc.