CLINICAL CASE DECISION INSTRUCTIONS
Grading Criteria for Clinical Case Decisions:
The highest potential points for each Clinical Case Decision Question are 15 points. Students are required to upload their responses as a Word document attachment to the assignment Dropbox.
- Your comments should be substantiated and substantive. Postings require two citations from one scholarly journal and one from the course textbook.
- To gain full credit for the assignment, each question must be at least onetwo pages, but no more than two (2) pages in length total.
- Students are required to use APA format, proper citations, and references.
- Students will choose the question they want to answer listed below.
Clinical Decision Cases
There are five cases listed below. Begin with a focused exam assessment; you decide if it should be treated as episodic with rationale.
You will choose one of the cases listed to provide an analysis. All cases should include the following:
a. Pathophysiology and pharmacology of the disease
b. Expected signs and symptoms of the disease
c. Nursing diagnosis with a plan of care
d. All questions pertaining to the case as listed under each case
Case 1. Mr. Appel has severe chronic obstructive pulmonary disease (COPD). He is admitted to the hospital with a respiratory infection and increased dyspnea; yellow, purulent sputum; anxiety; and diaphoresis. He states he feels weak and tired. He routinely takes a diuretic (furosemide) and his pulmonary medications. The following laboratory values are obtained:
Arterial blood gases:
pH 7.25 Serum sodium (Na+) 140 mEq/L
PaO2 60 mmHg Serum potassium (K+) 2.0 mEq/L
PaCO2 78 mmHg Serum chloride (Cl) 105 mEq/L
HCO3 34 mEq/l
a. What type of electrolyte imbalance does Mr. Appel have?
b. Interpret his ABGs.
Case 2. Mr. Jones is admitted to the hospital with an exacerbation of heart failure. He has +3 peripheral edema of the lower extremities.
a. What are the possible causes of his peripheral edema?
Case 3. Carl is a 15-year-old admitted to the hospital following a closed head injury during a motor vehicle crash. He is diagnosed with the syndrome of inappropriate anti-diuretic hormone (SIADH).
a. You would monitor him for what signs and symptoms?
Case 4. Identify the intracellular and plasma buffer systems and discuss how they function.
Case 5. Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:
Serum glucose 412 mg/dl
Serum sodium (Na+) 156 mEq/l
Serum potassium (K+) 5.6 mEq/l
Serum chloride (Cl) 115 mEq/l
Arterial blood gases (ABGs):
pH 7.30; PaCO2 32 mmHg; PaO2 70 mmHg; HCO3 20 mEq/l
a. What type of water and solute imbalance does Ms. Brown have?
b. What do her ABG results indicate?
c. Does she have an anion gap, and what does this indicate?
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