Reference no: EM133955515

Question

A 56-year old maintenance worker, with a past medical history of insulin-dependent diabetes, CHF, and hypertension, presents to the emergency room with lightheadedness, lethargy, and periods of confusion. Patient family members found him unconscious outside. Wife states, "he's been at it for over a week now" Medications: Insulin, Lasix, Digoxin, and Vasotec: Vitals on admission were as follows : Temperature/ Pulse/ Respirations /Blood Pressure 36.7C 118 18 103/61 On examination, the patient has slurred speech with decreased upper and lower motor strength bilaterally 4/5. While examining the patient, he experienced a loss of consciousness that lasted less than half a minute. The nurse drew labs, administered oxygen via NC, Established IV line access and placed the patient on a monitor. Lab results Electrolytes - in the emergency room Hematocrit - 38% Hemoglobin 12 gm/dL Potassium 3.3 mEQ/L Chloride 95 mEq/L Sodium 147 mEQ/L Phosphorus 2.6 mg/dL Bicarbonate 21 mEq/L Calcium 7.6 mg/dL BUN 46 mg/dL Creatinine 2.4 mg/dL Magnesium 1.3 mEq/L Albumin 4.1 g/dL Serum Osmolarity 321 mmol/kg Glucose 389 mg/dL Urine Drug Screen - Negative This client has been diagnosed with Cerebrovascular accident, secondary to type 1 diabetes, congestive heart failure and hypertension. State the priority nursing management if this client is placed in ICU.

1.a. Calculate the patient anion gap.

b. When managing this azotemic state, what is considered to be a priority action?

c. Which fluid resuscitation is best indicated for a patient whose BUN is 69 and creatinine is 2.9?

2. From your anion gap calculated, state what is meant by this value as it relates to the patient

3. What is the medical management for a client with elevated K+?

4. Calculate the serum osmolarity for this patient - What replacement is expected should the osmolarity be less than 240mOm/Kg.