What are the possible causes of his peripheral edema?

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Clinical Decision Case 1
Instructions
CLINICAL CASE DECISION INSTRUCTIONS

Grading Criteria for Clinical Case Decisions:

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The highest potential points for each Clinical Case Decision Question are 15-points.  Students are  required to upload their response as a word document attachment to the assignment drop box.

Each uploaded response is worth a possible 15 points.

1.       Your comments should be substantiated and substantive. Postings require two citations from 1 scholarly journals and/or 1 outside textbooks. Textbooks assigned to this course may be used for an additional citation only.

2.       Each of the two references must be from a different reference source.

3.       To gain full credit for the assignment, the response must be a full page discussion, but no more than two pages in length, which includes the reference list.

4.       Students are required to use APA format, proper citations, and references.  Students using direct quotes from referenced sources in the body of the paper must include quotations.

5.       Students’ first initials of their last names will determine which question they will provide an answer to for their clinical case assignment. (Students are encouraged to review each question and research the correct answers to increase their knowledge of the varied topics in the course).

6.       Students will be assigned to a question.

7.       Faculty will send the list of assigned questions and student names to each group.

Clinical Decision Cases

1.   Mr. Appel has a 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.

2.   Mr. Jones is admitted to the hospital with an exacerbation of heart failure. He has +3 peripheral edema of the lower extremities. What are the possible causes of his peripheral edema?

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 syndrome of inappropriate anti-diuretic hormone (SIADH). You would monitor him for what signs and symptoms?

4.   Identify the intracellular and plasma buffer systems and discuss how they function.

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

1. What type of water and solute imbalance does Ms. Brown have?