Oxygenation

Mai Nguyen has been complaining of fatigue and a persistent cough for approximately 2 weeks.  Nam scheduled an appointment for her at the clinic where you are a nurse.  Mrs. Nguyen appears disheveled. Her clothes are mismatched and rumpled, and her hair is tousled.  Normally she is dressed neatly and wearing makeup.  She has a hard time signing in at the desk and tells the receptionist she has a 1pm appointment, but it is now 9am. Mrs. Nguyen's vital signs are: BP 142/90; HR 94; Resp 24; temp 99.6�F. She is very confused and her weight has dropped 7 pounds since her visit last month. Her mucous membranes are dry, and she is dyspneic with any activity.  She is diagnosed with pneumonia.  Because of her rapid decline, Mrs. Nguyen is admitted to the hospital to receive intravenous antibiotics.  At the hospital, her pulse oximetry reading is 90% and she is unable to cough up secretion.  After 4 days in the hospital she is discharged home. She asks the nurse, ""What can I do to make sure I never get that sick again? ""How would you answer this question?

Fluid, Electrolytes, & Acid-Base Balance

Nam has been prescribed Lisinopril, hydrochlorothiazide and metformin.  Today at the clinic he had blood drawn for analysis.  The following are the results.

Sodium  136

Potassium  3.0

Chloride 96

Bicarbonate  24

BUN   18

Creatinine  0.8

 

Lippincott advisor Lab values

Sodium: 135-145

Potassium: 3.5-5.0

Calcium:8.5-10.5

Chloride: 96-108

BUN: 7-18

Creatinine: 0.6-1.3

Bicarbonate:23-29

 

 

Compare the lab work with the norms listed in the lab & diagnostic reference on Lippincott Advisor. Determine which labs are out of the normal ranges and give an interpretation of the abnormal results.

What additional assessment data would be useful to gather at this time?"

Oxygenation

 Response to Mrs.  Nguyen's Question:Answer to the Question of Mrs.  Nguyen

 

 To help prevent future episodes of severe illness like pneumonia, consider advising Mrs.  Nguyen on the following:The following is information that may be useful in order to prevent future episodes of severe illnesses such as pneumonia:

 

 Vaccinations:

 

 Pneumococcal Vaccine: Against pneumococcal pneumonia which might be important for the elderly and clients with chronic illness.

 Influenza Vaccine: Reduces the rate of flu which is one of the main causes of pneumonia, more so among the at-risk population.

 Healthy Lifestyle:

 

 Balanced Diet: Feed well so that your body could be strong enough and free from different sicknesses. Amongst the best things that has to be taken when in a need of boosting Immune system includes; fruits, green Veggies, whole grain foods , proteins.

 Regular Exercise: Exercise in as much as she maybe capable of depending on the condition that she is suffering from. Much as exercise is famous for all the health complications that are associated with it, it has been ascertained that it is favorable, especially to the lungs.

 Smoking Cessation:

 

 Avoid Smoking: If Mrs. Nguyen is a smoker. the following are true; there is a reduction in respiratory tract infections and improvement of the symptoms associated with chronic lung diseases and she will improve if she stops smoking.

 Hygiene Practices:

 

 Hand Hygiene: The findings of the present study have clearly indicate that washing of hand does have a significant part to play in preventing; various types of infection.

 Avoiding Illness Exposure: Stay away from people who are sick and use your hands constantly to wash them most especially during winters when flu prevails.

 Regular Health Check-ups:

 

 Routine Medical Visits: Visits to the HER physician in order to discuss ones health status and the handling of the diseases that are an issue to the client.

 Home Environment:

 

 Maintain a Clean Home: Measures against dust and the other agents brings about the health of the respiratory systems.

 The regulation of body weight: electricity and electrolytes; acid base balance

 

 Lab Work Interpretation:

 

 Potassium:

 

 Lab Value: 3. 0 mEq/L

 Normal Range: 3. 5-5. 0 mEq/L

 Interpretation: Here the record shows that potassium level is low this is referred to as – hypokalemia. Diuretic such as hydrochlorothiazide has a tendency to cause hypokalemia due to increase potassium excretion. Hypokalemia; symptoms/manifestations include; muscle weakness, fatigue/ weakness, muscle cramps and arrhythmias.

 Sodium:

 

 Lab Value: 136 mEq/L

 Normal Range: 135-145 mEq/L

 Interpretation: Sodium is normal The patient’s sodium levels are normal hence he or she is within the normal internal environment or milieu.

 Chloride:

 

 Lab Value: 96 mEq/L

 Normal Range: 96-108 mEq/L

 Interpretation: The chloride is a little low at 98 and this is not an abnormally low chloride value, however it is considered low in the normal frame work.

 Bicarbonate:

 

 Lab Value: 24 mEq/L

 Normal Range: 23-29 mEq/L

 Interpretation: That of the Bicarbonate is normal.

 BUN:

 

 Lab Value: 18 mg/dL

 Normal Range: 7-18 mg/dL

 Interpretation: As it has been pointed out earlier to almost normal it has now reached the upper limit with the value of 24mg/dl. Elevated levels of BUN may be due to the particular hydration state of a man and work of the kidneys.

 Creatinine:

 

 Lab Value: 0. 8 mg/dL

 Normal Range: 0. 6-1. 3 mg/dL

 Interpretation: Creatinine is also normal and this implies that the Kidneys are eliminating Creative as it should.

 Additional Assessment Data:

 

 Electrolyte Levels:

 

 Monitor Potassium: As a result it becomes appropriate to ask for signs and perhaps alter the patients drugs or diet.

 Hydration Status:

 

 Check for Dehydration Signs: For them, screen for other manifestations of either dehydration or fluid on blood since they affect BUN level.

 Cardiovascular and Neuromuscular Symptoms:

 

 Monitor for Symptoms: One should conduct a search for any sign that can be attributed to low potassium such as; fatigue, muscle twitching or a rapid heartbeat.

 Medication Review:

 

 Assess Current Medications: Assess the usage of such drugs particularly the hydrochlorothiazide on the balance of the electrolytes.

 Dietary Intake:

 

 Evaluate Potassium Intake: The need arises as well to discuss in detail the diet and assess how much potassium a person consumes.

 With specific reference to the above aspects, you will have a clearer way of approaching the medical conditions of Mrs. Nguyen’s and Nam and the things that could be done in the future and the things that could be monitored.