[Answered]: Patient Profile: Frances, a 78 years old that lives…

Patient Profile: Frances, a 78 years old that lives alone, is admitted to the hospital because of weakness and confusion. She has a history atrial fibrillation and chronic heart failure (HF). On admission it is noted that her at home medications include Digoxin (Lanoxin), Furosemide (Lasix), Metoprolol, Diltiazem and Levothyroxine. Objective Data: Neurologic: Confused; slow to questioning; generalized weakness; states she has trouble focusing his vision- people look green with halo’s Cardiovascular: BP 100/59; HR 55 irregular; peripheral pulses weak; ECG indicates Atrial fibrillation with controlled ventricular response Pulmonary: Respirations at 12/min; shallow Skin: decreased turgor; dry mucous membranes Laboratory Results: Digoxin level 1.0 ng/ml Electrolytes • Na+ 134 mEq/L • K+ 2.5 mEq/L • Mag+ 1.2 mEq/L • Cl- 88 mEq/L • BUN 42 mg/dL • Creatinine 0.9 mg/dL • Glucose 122 mg/dL (random) • CO2 31 mEq/L CBC • RBC 5 x 106/uL • WBC 7,000/uL • Hemoglobin 14 g/dL • Hematocrit 50% • Platelets 250,000/uL ABG • pH 7.55 • PaO2 88 mm/Hg • PaCO2 45 mm/Hg • HCO3- 42 mEq/L Critical thinking questions: 1. Evaluate Frances’ fluid volume and electrolyte status. Which physiological assessment findings support your analysis? Which lab results support your analysis? What is the most likely etiology of these imbalances? 2. Explain the reasons for Frances’ ECG changes? 3. Analyze the ABG results. What is the etiology of the primary imbalance? Is the body compensating for this imbalance? 4. What has Frances’ advanced age placed her at risk for fluid imbalance? 5. Discuss the role of aldosterone in the regulation of fluid and electrolyte balance. How will changes in aldosterone affect Frances’ fluid and electrolyte imbalances? 6. What are the primary daily assessments that the nurse will complete? 7. What would be the priority nursing problem (s)? 8. What burning questions does the astute nurse have for Frances? 9. Which collaborative team members might you contact to ensure safe discharge?